June 18, 2012

Surgical InstrumentsDespite the common wisdom of most doctors and patients that clostridium difficile is primarily a threat to elderly, hospitalized people, recent studies indicate that not only are cases of “community-onset” C. diff growing but they are more likely to result in surgery and other serious complications.

In April, the Infection Control and Hospital Epidemiology journal published a study from the Centers for Disease Control, that found people who developed a C. diff Infection outside of the hospital setting were four times more likely to require a colectomy (surgical removal of the colon) than those who developed symptoms while hospitalized. And people 65 or older are at even higher risk.

People in the community, including those living in nursing homes or recently treated in physicians offices, were previously thought to be at low risk for C. diff.  The CDC study showed that up to 75% of all C. diff infections show up in community settings.

The combination of increased infection rates and a larger percentage of people becoming symptomatic outside of a hospital speaks to the growing trend and severity.

While the study doesn’t speculate as to the reasons why community-onset cases more frequently lead to colectomy, from my own experience, I suspect the following reasons:

  • Unlike MRSA and pnuemonia, the public is largely ignorant to both the existence and danger of clostridium difficile infections.
  • Therefore, people who become symptomatic outside of the hospital are likely to assume that their symptoms (diarrhea, fever) are the result of a virus or food poisoning and delay treatment.
  • Many physicians and healthcare providers working outside of hospital settings hold outdated notions of what a “C. diff patient” looks like (i.e. elderly, hospitalized, immuno-suppressed) and, therefore, miss the tell-tale signs.
  • Finally, there is a new, hypervirulent strain of C. diff that has emerged wherein the toxins produced by the bacteria are much stronger and cause great damage to the patient more rapidly than older strains.

To protect yourself and your loved ones, keep in mind that C. diff symptoms can appear long after your last hospitalization, visit to a nursing home, or doctor’s office. Remain vigilant for C. diff symptoms in anyone who has recently been in a hospital or healthcare setting, particularly if they are taking or have recently taken antibiotics.

You can read more here:

Vital Signs: Preventing Clostridium difficile Infections.  (free registration required)

Community onset Clostridium difficile linked to higher risk of surgery

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28 Comments

  1. Pat mastors says:

    Christian, c-diff is becoming a “stealth” killer, for the reasons you so astutely cite. In state HAI reporting committees like the one on which I serve, we spend ludicrous amounts of time just defining what “hospital-acquired” means (not the Group’s fault; there are several ways to define…and hospitals are penalized for adopting more rigorous definitions that make their incidence levels look higher by comparison)

    There is too little focus on preventing infection like C-diff in the first place…I honestly think only public engagement/resolve wil ultimatelyl impact the problem.

    Thank you and the Peggy Lillis Foundation for all you do to advance this agenda.

    1. Christian says:

      Thanks, Pat! At the risk of being a mutual admiration society, your advocacy and good counsel have meant a lot to us.

  2. Kathy says:

    Christian
    I am a 40 year vegetarian, I watched everything that I put in my mouth.
    I had 2 bouts of diverticulitis in 6 months one w/abscess. I was shocked. The Dr.s thought it was strange that I was getting such stomach distress. Last August I had 8 inches of my colon resected. I was taken aback when the doctor preparing the I.V said “diverticulitis, C-diff they are the same.”. The thing that struck me was for the 3 days that I was in intensive care there sat 3 plastic containers of the approved c-diff cleanser not once used while I was there. I was angry. It been almost a year. I take loads of probiotics. I watch what I eat. Idrink gallons of water and walk to maintain my health. I am feeling much better, but I am still angry. Thanks for the information and keep it coming.

    1. Christian says:

      Thanks, Kathy, for sharing your experience. As far I know, diverticulitis and C. diff are not the same thing. Diverticulitis is a disease caused by inflammation of the small sacs within the intestines, whereas C. diff is a bacteria that causes colitis.

      I’m glad you’re feeling better. If you’re open to it, we’d be grateful if you shared your full story since it seems pretty distinct from the others we currently have on the site. You can reach me directly at cjlillis@peggyfoundation.org.

      1. Kathy says:

        Christian:
        That goes to show how little they know or care to share with general population. This is the hospital’s and medical profession’s disease. That is where I got it. I had diverticulitis in May I had antibiotics, Z-pack for a respiratory infection the July before. C-Diff is a well kept secret. I was an EMT for years and never heard the term bantered around the medical community. The hospital sent me home no instruction about how to get rid of this problem or how to protect my family members. Shame on them. Doesn’t it make you wonder why within the last couple of years “colon health” commericials have become so popular? That” because the health profession knows it a BIG problem. One can be sure that eating Activia will not even begin to help. Just call it what it is. Sorry for the rant but I am angry.

        As far as the C-Diff/Divert. I do get the connection. Does one cause the other we will never get a straight answer out of the medical community. I’ve been 14 months C/Diff free, but I’m sure it still lays dormant. It is being kept at bay with good quality strains of probiotics.

        1. Denise says:

          I contracted CDiff “in community beginning of last March. Presented at doctor doubled over with sever abdominal pain. Thought maybe I had a kidney stone. Have auto immune with diarrhea for over 23 years and D was no worse and no bad odor so didn’t connect any dots. Never heard of CDiff. CT done and colon so inflamed there was major concern of rupture. Toxin B, not A. 2 courses of antibiotics where Infectious Disease told my doc no more antibiotics Because they weren’t working. Idiots! Killed the infection, not the spores! No amount of PB’s, fermented foods, anything helped. FMT in July. Now flare after flare of diverticulitis. All info says not associated. I think CDiff caused more pockets and now in process of elimination of foods that seem to cause flare. Terribly afraid I’m gonna loose colon. Looks shot full of buckshot. Don’t know what to do

      2. Trish says:

        I just got out of hospital after 7 days of c diff and colitis. Husband just went to hospital today and wa dx with c diff and diverticulitis which he had for 3rd time in January. Did his cdiff cause that. I feel so guilty. My was from 20 days of abx

  3. sandy says:

    I recently have been diagnosed with c-diff, can you get this from working with people getting out of jail and prisons?

    1. Christian says:

      Hi Sandy –

      It would really depend on how you were working with them and whether or not those people are symptomatic or colonized with C. diff. I’m not aware of any C. diff outbreaks within prisons or jails, but given the close confines it certainly seems possible. Why do you think that’s the connection for you?

      1. Sandy says:

        Go to page 4, I am in the front window of people who come to probation after they get out of prisons, and jails. I cook for 7 people in my family, none of them of gotten this. I go to work, do school at home and sleep. Once I was diagnosed with c-diff I told my job, they didn’t do anything until a week later when a co-worker told them that it was contagious. I was taken to a office, asked what I had and then told I had to leave work until I was not contagious. I asked them why couldn’t this have been contracted from the job, I was told I was the only one with it and no proof it came from the job. But, as you can read on this site, which is one of their sites, it is well known to be in prisons and jails. But, I am being treated like I have a plague. I hope the site I put in here works for you, if not, I went to google, typed in c diff in prisons, 2nd one down, disease lockdown 2011, it’s no secret but they act like it is. It is so sad that this can be swept under the carpet when it can be a very serious problem to so many people.

        1. Trish says:

          I just got out of hospital after 7 days of c diff and colitis. Husband just went to hospital today and wa dx with c diff and diverticulitis which he had for 3rd time in January. Did his cdiff cause that. I feel so guilty. My was from 20 days of abx

  4. sandy says:

    Work with people getting out of prisons and jails regularly. Front desk clerk.

  5. Sandy says:

    read page 4, it explains alot. If the site doesn’t work, go to google, type in c diff in prisons, look for disease lockdown spring 2011.

  6. Sandy says:

    Individuals in prisons,jails, detention centers, and other correctional facilities are at high risk for acquiring these infections.

    1. Christian says:

      Sandy – Thanks so much for this information. I’m going to blog about it so it reaches more people.

  7. Tracy says:

    I was just dx’d with C-Diff last week. I have not taken any antibiotics in over a year, and have not been in the hospital for more than 2 years. So how did I get it??? I’ll never know. I am 45 years old and in good health. Was dx’d with Shingles about a month ago….don’t know if the Shingles virus weakened my immune system and prevented me from fighting off C-Diff when exposed to it. It worries me sometimes….if I have some underlying disease that has compromised my immune system….

  8. Misty says:

    I was diagnosed with c diff 2 years ago and it took 3 rounds of vancomycin to clear up. I was hospitalized in 2009 for diverticulitis and given numerous rounds of flagyl and cipro which is what opened the door for c diff to grow. My GI Dr. told me i can’t take antibiotics ever again. How can I make sure I don’t get c diff again though?

    1. Angela Kelly says:

      Hi Misty,
      We are so sorry to hear about your battle with C. diff. The best thing you can do to avoid a future C. diff infection is to avoid antibiotic use unless absolutely necessary. As well, you can take a high quality probiotic with any necessary antibiotic use, make sure to space the probiotic three hours from taking the antibiotic.

  9. Valerie says:

    If I was in hospital with c.diff p, my room and I would be cleaned and disinfected. But I am at home and at age 75 and weak I am supposed to clean, sanitize, and disinfect all hard surfaces.. of which there are hundreds in a house, with bleach and water, do my laundry separately with bleach, hose myself down once, twice, three times a day. No help from any agency. spouse is not in best of health, and and I don’t want him to get it. I have had no visitors .. don’t want to expose them, and rarely go out… this is one form if hell after living with ibs d for 15 years, and then Seven antibiotics in eight months for UTIs. My GP hasn’t even sent me to a gastro dictor. am ai angry? Yes. Consolations to everyone who is dealing with this obnoxious disease.

    1. Angela Kelly says:

      Hi Valerie,

      C. diff is indeed obnoxious, to say the least! I am so sorry that you are dealing with this terrible infection. If you need help locating a gastroenterologist or infectious disease doctor who is knowledgable about C. diff please feel free to reach out.
      -Angela

    2. Gina says:

      I feel you . This disease is a full time job at home. Im caring for my husband with c diff colitis. It made him incontinent too. I spend all day cleaning disinfecting laundry etc. im ready to drop dead myself. We are in our 60’ s he has ulcerative colitis and has to self cath to pee also. All they said was your hands good. Im a retitrd nurse so know what to do. I don’t understand why they dont tell people how to keep this from spreading. Its scary ,we have kaiser. I want to write to the infectious disease dept and see if they know this is happening

      1. Lin says:

        My husband has Crohn’s and is in his second round of antibiotics because of c-dif . He tells me his doctor said not to worry about infecting others, only those who are immunocompromised have to worry. We have 5 kids ages 7-15 and I have rheumatoid arthritis and am on pred, plaquenil and assorted pain meds. I’m very worried, I have a horrible stomach issue going on and a cold that won’t go away for over a month. Am I right to be worried? I’m freaking out, we only have one bathroom and he’s not being especially clean, he thinks it’s not a big deal, that he’s not infecting anyone. Am I right to worry? If anyone has any website suggestions that I can send him. I sent the CDC info to him but he just blew it off.

  10. Kathy says:

    I was just diagnosed with C-diff. I started the antibiotic today. How long before you are no longer considered contagious

    1. Angela Kelly says:

      Once diarrhea has resolved you should no longer be contagious. Be sure to practice careful hand hygiene. Wishing you a speedy recovery!

  11. Claudia says:

    I was diagnosed with c-diff after numerous rounds of diverticulitis which is still ongoing. Now on vancomycin 1st round after flagyl which is the antibiotic for diver. Was in emerge for ct scan with very little sanitation there. How does one clean so thoroughly at home without a vicious circle happening?

  12. Mary says:

    I had surgery for diverticulitis in jan after long hospital stay i now have severe cdiff on vancomycin 4 x aday been a week not working .snyone know whats next? Waiting on call from gi dr

  13. Nancy says:

    Lymphocytic colitis as a result of Cdiff in 2017. I now test positive for Cdiff again. No idea if massive D is caused by colitis or Cdiff. I’m also very bloated, extremely. I’m thinking SIBO, but I’m not a Dr. Cannot find a good gastro here in South FL. I do have a good infectious disease Dr. I had a round of dificid in 2017 after 3 rounds of vanco did not work. I recently had a round of Dificid again. Still testing positive. I have no idea what to do. It’s 6:15 am and the explosive D has been going on for hours. I live alone, so no help. Have to keep cleaning woodwork, bathroom door, side of bureau. It’s that explosive. Any suggestions appreciated.

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