C. diff-or clostridium difficile-is a spore-forming, toxin-producing bacterium that infectious disease experts are saying is taking the path of methicillin-resistant Staphylococcus aureus-MRSA-and is moving from within hospitals to the community at large. Like MRSA, C. diff has become multi-drug-resistant. Although this disease mostly affected elderly, hospitalized patients, a bolder strain of C. diff is now crippling the robust.
C. diff is part of the natural flora, or bacteria, in the colon and is an ancient bacterium. Many people can, and do, carry it naturally and it can live in us without causing disease. Carrying C. diff in us does not mean we have an infection. The problem arises because what we don’t have is the receptor for the toxin-the molecular key that unlocks C. diff’s toxin-spewing capacity. Newer, mutant C. diff is fully equipped with the receptor and is capable of boosting the amount of toxin produced; the toxin makes C. diff lethal, causing potentially fatal intestinal inflammation.
The Greater New York Hospital Association is calling for the placement of sinks in hospital hallways to allow staff access to more convenient and frequent hand washing opportunities. While alcohol-based hand sanitizers, common in hospitals, can kill MRSA and other bacteria that contaminate the hands of health care workers, they are powerless against C. diff’s spores. Surfaces touched by C. diff patients must be cleaned frequently with bleach. In Britain, long-sleeved lab coats, for centuries a symbol of the medical profession, are being discouraged because C. diff spores can attach to the sleeves and be transmitted to patients. C. diff spores can colonize on virtually anything in a hospital room. C. diff killed more people in European hospitals last year than MRSA and at a teaching hospital in Philadelphia, three patients who consecutively occupied the same room came down with C. diff; one died.
C. diff is problematic because it produces hardy spores; New York is one of 23 states the Centers for Disease Control and Prevention (CDC) has identified as having a highly toxic mutant strain. The full extent of community-acquired C. diff remains unknown and most of what’s known about it as a pathogen comes from CDC hospital data. C. diff was first recognized as a hospital microbe in 1978; by 1996 it had increased to 31 cases per 100,000 people discharged from US hospitals, and in 2003-the most recent year for complete statistics-prevalence rose to 61 per 100,000 cases. Now, and for the first time, C. diff is being seen outside of hospitals.
Hospitals must isolate patients infected with C. diff and halt its transmission. No easy task, given that C. diff spreads rapidly in hospitals. Hospitals nationwide are considering tests to screen patients before admission. All diarrhea cases should be assumed to be of C. diff origin until lab results prove otherwise.
In addition to MRSA and C. diff, doctors are concerned about Acinetobacter baumannii, an often drug-resistant organism causing difficult-to-treat infections among wounded soldiers in Iraq. In some cases, Acinetobacter baumannii has proven more challenging than the war injury.
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