Despite 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• Many physicians and healthcare providers working outside of hospital settings hold outdated notions of what a “C. diff patient” looks like (i.e. elderly, hospitalized, immuno-suppressed) and, therefore, miss the tell-tale signs.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