C-diff article

--"the development of C. difficile infection (CDI) commonly has 2 essential requirements: (1) exposure to antibiotics and (2) new acquisition of C. difficile such as that occurring via fecal-oral transmission. Although some people exposed to these two factors will develop CDI, others may only become asymptotically colonized. A third factor, related to host susceptibility of bacterial virulence, is thought to be an important determinant for developing disease.

http://apic.org/Resource_/EliminationGuideForm/59397fc6-3f90-43d1-9325-e8be75d86888/File/2013CDiffFinal.pdf

--"incubation period of C. difficile following acquisition is short (median of 2-3 days)... in contrast, the effect of antibiotics on the lower intestinal micro-biota is much longer lasting. Recent epidemiologic evidence indicates patients remain at elevated risk for CDI for 3 or more months after they have stopped antibiotic treatment."

--"In the United States, the rate of hospital discharges with CDI listed as any diagnosis increased from 3.82 per 1,000 discharges in 2000 to 8.75 per 1,000 discharges in 2008; with a disproportionate increase among persons 65 years of age and older." (That's 228%)

--"Persons 65 years of age or older have been most affected, representing over two-thirds of patients with CDI."

--"During this period of rising incidence of CDI...a greater number of severe cases associated with higher numbers of colectomies, treatment failures, and deaths were reported than ever before."

--"In 2009, 92 percent of deaths from C. difficile occurred among persons 65 years of age or older, and C. difficile was the ninteenth leading cause of death in this age group."

--Part of this change in C. difficile epidemiology has been attributed to the emergence of a hypervirulent epidemic strain of C. difficile." (BI/NAP/027-- higher toxin production compared to other strains, also has a third toxin while other strains only have 2, resistant to fluroquinolone class of ABT)

--"CDI should be suspected in any patient with diarrhea or abdominal pain and a recent history of antibiotic use, healthcare exposures, or in patients with unexplained leukocytosis. Severe CDI has also recently been reported in low risk populations—that is, people without recent antibiotic or healthcare facility exposures— therefore, CDI should be considered in any patient who has diarrhea lasting longer than 3 days and has a fever or abdominal pain"

--only patients with diarrhea should be tested, as there are lots of false-positives and false-negatives in asymptomatic patients... "Persistently positive test results at the end of treatment are not predictie of C. difficile relapse, and a 'test of cure' at the end of therapy should not be performed."

--"Routine use of repeat testing is discouraged."

--"Only watery or loose stool should be collected and tested to establish the diagnosis of CDI."

--"Most diagnostic tests involve the detection of C. difficile toxins A and B."


--C-diff spores can survive for months! (on equipment, personal items, or hard surfaces) They are highly resistant to cleaning and disinfection measures.

--spores are important for transmission, as transmission is via fecal-oral route, and spores make it possible for the bacteria to survive stomach acid; "after ingestion, the spores can germinate, produce toxins, and cause disease."

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