Cases of Colon Infection Increasing
A dangerous bacterial infection that often occurs in older, severely ill patients who have taken antibiotics or recently have spent time in a hospital has begun to occur more often in younger, previously healthy individuals without traditional risk factors, according to three reports released on Thursday, the Washington Times reports (Howard Price, Washington Times, 12/2).
Infection by Clostridium difficile, which led to 100 deaths at a Quebec hospital in 2004, can result in diarrhea, as well as colitis, perforation of the colon, sepsis and death. Almost 3% of previously healthy adults and 20% to 40% of hospitalized patients are "colonized" with C-diff. In most cases, hospital personnel who have come in contact with a contaminated surface or medical device transfer C-diff to patients (Ellis Nutt, Newark Star-Ledger, 12/2).
C-diff is spread by spores in feces that are difficult to kill with regular household cleaners and is resistant to some antibiotics used to fight bacteria in the colon (Washington Times, 12/2). In addition, some antibiotics kill other microbes that help prevent infection with C-diff.
In the first report, published in the New England Journal of Medicine, Vivian Loo and colleagues at McGill University found the strain of C-diff that caused the Quebec outbreak mutated to become more resistant to the class of antibiotics called fluoroquinolonas and was fatal in 6.9% of cases. For the second report, also published in NEJM, researchers led by L. Clifford McDonald of CDC collected 187 C-diff samples from eight health care facilities in Georgia, Illinois, Maine, New Jersey, Oregon and Pennsylvania.
The report found the same strain of C-diff at all of the health care facilities. A third report, also compiled by McDonald and colleagues and published in the CDC Morbidity and Mortality Weekly Report, found at least 33 cases of C-diff reported since 2003 in New Hampshire, New Jersey, Ohio and Pennsylvania, with previously healthy individuals involved in 23 of the cases.
A related editorial written by John Bartlett of the Johns Hopkins University School of Medicine also appeared in NEJM (Stein, Washington Post, 12/2).
"We think C-diff is much more widespread (than these findings indicate). It's not a nationally reportable disease, and there is not a formalized surveillance," McDonald said (Washington Times, 12/2). He added, "We are very concerned about this. It's still probably an unusual occurrence in healthy people, but we're concerned enough that we want to alert people" (Washington Post, 12/2).
McDonald said, "Hospitals need to be conducting surveillance and implementing control measures. And all of us need to realize the risk of antibiotic use may be increasing" as C-diff mutates (Stobbe, AP/Houston Chronicle, 12/2).
An abstract of the Loo report is available online.
An abstract of the McDonald report published in NEJM also is available online.
In addition, the McDonald report published in MMWR is available online.