Contemplating medicine and the health care system
I have heard two excellent talks on this subject over the past month. The current CMAJ has an important article about C diff – Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection
C diff now enters the differential diagnosis in patients presenting with sporadic diarrhea, even without recent antibiotic exposure.
Of the 836 cases, 442 (52.9%) had no exposure to antibiotics in the 45-day period before the index date, and 382 (45.7%) had no exposure in the 90-day period before the index date. Antibiotic exposure was associated with a rate ratio (RR) of 10.6 (95% confidence interval [CI] 8.9–12.8). Clindamycin (RR 31.8, 95% CI 17.6–57.6), cephalosporins (RR 14.9, 95% CI 10.9–20.3) and gatifloxacin (RR 16.7, 95% CI 8.3–33.6) were associated with the highest risk. The RR for C. difficile infection associated with antibiotic exposure declined from 15.4 (95% CI 12.2–19.3) by about 20 days after exposure to 3.2 (95% CI 2.0–5.0) after 45 days. Use of a proton pump inhibitor was associated with increased risk (RR 1.6, 95% CI 1.3–2.0), as were concurrent diagnoses of inflammatory bowel disease (RR 4.1, 95% CI 2.6–6.6), irritable bowel syndrome (RR 3.4, 95% CI 2.3–5.0) and renal failure (RR 1.7, 95% CI 1.2–2.2).
Almost half their patients had no antibiotic exposure during the previous 45 days!!!
C diff is following MRSA as an endemic infection. We have a responsibility to consider this diagnosis in cryptic ongoing diarrhea.
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1 Response to Community acquired C Diff
Gabrielle Meunier
February 15th, 2009 at 6:47 pm
In all this Salmonella Typhimurium mess and Peanut Butter, my son presented both C-Diff (community acquired) and this Salmonella at the same time. He had absolutely no “Community” exposure. Whatsoever. I am trying to learn all I can. Can you appraise me on any research you have been privy to as towards why C-diff is “growing” in the community? Thanks!