This weekend, Canadian newspapers reported an outbreak of C. difficile in a Quebec hospital.
Since July, nine people have died resulting from complications of C. difficile infection. C. difficile infection causes severe diarrhea in patients compromised by antibiotic usage and underlying disease conditions. Elderly patients are especially at risk.
Although the media has presented the outbreak with an all too familiar fear-based message, suggesting that doctors believe the outbreak strain is a new and more powerful strain of C. difficile, there is no evidence to suggest that this strain differs from the hyper-virulent strain that caused a similar epidemic in 2002. Until laboratory testing types the strain, there is no reason to believe that this recent outbreak is not a re-emergence of the previous outbreak strain.
C. difficile is pretty much endemic in hospitals – while it may seem that you’ve gotten rid of it, it is not surprising for it to recur at some point in the future. C. difficile forms spores when environmental conditions are insufficient to support its growth. Therefore, it is difficult to kill it outside the body – stringent cleaning is necessary to remove it and it is difficult to clean every nook and cranny in a patient’s room or bathroom, for instance. So, it tends to hang around, especially in older hospitals where the infrastructure results in sharing of bathrooms by multiple patients. Many hospitals in Quebec are older - this might be a reason why the incidence of CDAD is much higher in Quebec - it is difficult to remove spores from facilities where it has become endemic, and where the infrastructure supports increased transmission.
Sources:
Jacques Pépin, Louis Valiquette, Benoit Cossette. Mortality attributable to nosocomial Clostridium difficile–associated disease during an epidemic caused by a hypervirulent strain in Quebec CMAJ 2005;173(9).
Jonathan Montpetit. Nine dead after C. difficile outbreak in Quebec. Canadian Press (Globe and Mail) .
