The sheer volume of new medical research and guidelines makes it nearly impossible for doctors and health care workers to stay current. Given the increasing virulence and changing epidemiology of clostridium difficile infections (CDIs) in the past 20 years, a large number of health care providers believe understandable but dangerous myths about CDIs.
The Peggy Lillis Foundation is committed to shattering these myths to help doctors provide and patients receive the best possible care.
Myth #1: C. diff is a nuisance disease
- From its identification through the 1990s, C. diff was considered a “nuisance disease” by doctors, afflicting primarily the immune-suppressed and the elderly, but treatable and rarely deadly
- However, starting in the 2000s, several large and fatal outbreaks in North America signaled that C. diff was evolving
- In 2003, outbreaks of the hyper-virulent NAP-027 strain in Montreal, Quebec and Calgary, Alberta, claiming more than 40 lives in a short period
- In 2013, the Centers for Disease Control and Prevention designated C. diff as an “urgent threat”
- In 2015, the CDC cited C. diff as “one of the leading causes of infectious disease death in the United States” causing an estimated 29,000 deaths in 2011
Myth #2: You can only get C. diff from a hospital
- While C. diff was initially considered a “hospital acquired infection”, over the past decade the number of cases occurring in the community has soared to 46.2% (or 345,400 cases), according to CDC
- 90% of those individuals did have some exposure to an inpatient or outpatient health setting prior to onset
- Generally, community acquired C. diff is less deadly than hospital onset infections (1.3% of patients with community acquired died within 30 days of diagnoses versus 9.3% of health care-associated CDI cases)
Myth #3: Only elderly people get C. diff
- While the elderly are most likely to contract a CDI, people of all ages are at risk
- 1/3 of all CDIs occur in people under 65 years old
- In fact, approximately 17,000 children are diagnosed with a CDI every year (Source)
- CDIs are increasingly found in health adults and new mothers, as evidenced by Lisa N., the O’Neals and Megan’s stories
Myth #4: Antibiotics don’t have side effects
- Antibiotic use is the primary risk factor for a CDI
- Antibiotics – particularly broad spectrum ones like clindamycin – kill off all gut bacteria, much of which is important to human health
- Other side effects include vaginal infections, nausea and vomiting. Serious allergic reactions include blistering rashes, swelling of the face and throat, and breathing problems. Some antibiotics can cause permanent nerve damage and torn tendons
- The Choosing Wisely campaign has an excellent briefing on when you need antibiotics and when you don’t
- Recent research suggests that indiscriminate antibiotic use, particularly in children, may lead to a range of adult ailments such as asthma and obesity
Myth #5: Testing negative for C. diff means that you are, without a doubt, free from C. diff.
- Most diagnostic tests for CDI cannot be performed on solid stools
- Rapid tests usually detect the presence of C. diff toxins, not the bacteria itself
- Toxigenic stool culture is considered the gold standard but it will not distinguish between C. diff colonization and overgrowth (i.e. infection), so a second test is required to detect the presence of toxins
- Since its possible to have C. diff bacteria in your stool after your symptoms have stopped, retesting to prove you’re cured isn’t advised
Myth #6: Watery diarrhea is the only symptom of C. diff.
- Thought watery, urgent diarrhea is the most common symptom of a CDI, atypical presentations do happen
- Tiara’s first symptoms were shooting pain on her lower right side, followed by nausea
- Maryann fainted while at work, leading her doctors to discover that she head a high white blood cell count and low red cell count
Myth #7: C. diff and other health care associated infections are unavoidable.
- While C. diff and other bacteria exist in the environment eliminating them from health care settings is not only possible, it’s necessary.
- We have the technology and knowledge to greatly reduce the number of CDIs
- England decreased CDIs in hospitals by more than half over three years by using infection control recommendations and more judicious antibiotic use
- Rhode Island Hospital recently reduced its number of CDIs by 70% and annual related mortality in CDI patients by 64% (Source)
If you’re a health care worker, patient or caregiver running into other C. diff Myths, please contact us to we can add them to our list.