Clostridium difficile Blog

"One Bum Per Toliet" to combat C. Diff.

C. difficile Attorney — Wed, 06 Jan 2010 19:25:02 -0800

According to the Globe and Mail, "the more roommates you have during a hospital stay, the greater your risk of acquiring a dangerous infectious disease such as Clostridium difficile, according to new Canadian research." The study, published in the American Journal of Infection Control, shows that each roommate a patient is exposed to hikes his or her risk of infection by 10 per cent.

Earlier research showed that about 225,000 patients a year suffer from hospital-acquired infections that substantially extend their stays, and between 8,000 and 12,000 people die annually as a result. infection. The new study was conducted at Kingston General Hospital, which has 451 in-patient beds and about 17,000 patients a year. There are 107 single-occupancy rooms, 83 double-occupancy, six triple-occupancy and 19 quadruple-occupancy, plus open bay areas and specialized units such as intensive care.

Dr. Zoutman said the likely reason that roommates increase the risk of infection is that patients share a washroom. (The mantra in infection control is: One bum per toilet.) Another likely explanation involves inadequate handwashing by patients and health professionals alike; doctors sometimes don't wash their hands between patient visits in a single room.

Washing Hands - H1N1 measures curb C. difficile infections

C. difficile Attorney — Sun, 29 Nov 2009 11:13:12 -0800

The fight against the swine flu seems to be having another positive effect in Quebec hospitals — combating the deadly C. difficile bacteria, Dr. Alain Poirier, the province’s chief public health officer, said Friday.

Last month, Quebec hospitals registered their lowest rate of infections from C. difficile in five years. And the swine flu pandemic may be partially responsible, Poirier said.

In October, there were 4.3 infections for every 10,000 patients in hospital — the lowest level since the province began closely tracking the C. difficile bacteria five years ago, Poirier said.

A major change in hospitals between then and now is that visitors and patients are constantly being reminded to wash their hands because of the H1N1 virus.

"Generally speaking, all the population has now understood that washing your hands is good for influenza," Poirier said. "But it's also good for a lot of other diseases transmitted by contamination of your hands."

Quebec began tracking C. difficile after a deadly epidemic in 2003, when most of the victims were elderly patients already in hospital. The bacterial spores are very difficult to clean off or kill.

C. difficile outbreak declared in Canada

Bill Marler — Thu, 19 Nov 2009 15:05:53 -0800

There is another outbreak of the Clostridium difficile bacterial infection at Nanaimo Regional General Hospital. Six months ago, the Vancouver Island Health Authority confirmed an end to an earlier C. difficile outbreak that began in July 2008. That outbreak affected nearly 100 patients and was directly responsible for five deaths.

Dr. Martin Wale, medical director for infection prevention and control, said C. difficile cases are again higher than expected at the Nanaimo hospital.

From mid-October to mid-November, NRGH saw 11 cases of C. difficile, well above the expected average of five patients with C. difficile at any one time. As of Tuesday, Wale said there are seven patients in isolation at NRGH with the infection, adding that two patients acquired the infection from the community. The health authority’s outbreak protocol requires enhanced cleaning, including a top-to-bottom cleaning of the entire hospital and more powerful cleaning chemicals.

Clostridium difficile - C. Difficile Hypervirulence Genes Identified

C. difficile Attorney — Mon, 28 Sep 2009 05:59:13 -0800

According to Science Daily, five genetic regions have been identified that are unique to the most virulent strain of Clostridium difficile (C. difficile), the hospital superbug. Researchers writing in BioMed Central's open access journal Genome Biology studied the genome of the bacterium, looking for genes relating to motility, antibiotic resistance and toxicity.

Brendan Wren from the London School of Hygiene & Tropical Medicine worked with a team of researchers at The Wellcome Trust Sanger Institute to compare the genomes of three strains of the bacterium, the hypervirulent '027' strain, an historic, non-epidemic 027 strain and one less related and also non-epidemic '630' strain.

He said: "C. difficile is the most frequent cause of nosocomial diarrhoea worldwide. In the past five years a new group of highly virulent C. difficile strains has emerged to cause outbreaks of increased severity in North America and Europe. Several studies have shown that patients infected with these '027' strains have more severe diarrhoea, higher mortality and more recurrences. This study provides genetic markers for the identification of 027 strains and offers a unique opportunity to explain their emergence."

The researchers found that the 027 strains had considerable genetic differences compared to the non-epidemic 630 strain, which may relate to the observed phenotypic difference in virulence. Additionally, five genetic regions appear to have accumulated over the last 20 years in the modern day epidemic 027 strain, compared to its historic counterpart.

According to Wren, "The observed gene differences between these strains might individually or collectively explain why modern 027 strains are more likely to be epidemic and could explain the higher case-fatality ratio and persistence associated with infection by these strains."

Scotland Reports Bump Up In C. diff Deaths: MRSA Down 8 Percent

C. difficile Attorney — Fri, 07 Aug 2009 11:17:23 -0800

As we’ve been following both Clostridium difficile (C. diff) and Meticillin Resistant Staphylococcus Aureus (MRSA), we’ve noted that both Superbugs get a lot of attention in the United Kingdom.

We are not sure if this is ever going to figure into the big health insurance reform debate in the United States, but public hospitals in England and Scotland appear to be places you might want to avoid if you want to escape both C. diff and MRSA.

For example, the ”Registrar General” in Scotland just reported that C diff claimed the lives of 248 last year, up 12.7 percent. What they call “the hospital infection” contributed to the deaths of another 517 Scots.

MRSA killed another 48 Scots in 2008, down 8 percent from the year earlier.

Last year started with a C. diff outbreak at the Vale of Leven Hospital in Dunbartonshire, causing death rates to peak in the first half of the year, and then decline some.

That was “cautious grounds for optimism,” according to Health Secretary Nicola Sturgeon, but not a reason to be complacent. The government is installing “an electronic bed management system” and “infection tracking software” to combat the Superbugs in the public hospitals.

Cepheid Receives FDA Clearance for First On-Demand Molecular Diagnostic Test for Clostridium difficile Infection

C. difficile Lawyer — Mon, 13 Jul 2009 13:23:44 -0800

Cepheid (CPHD) Monday announced it has received clearance from the U.S. Food & Drug Administration (FDA) to market its Xpert C. difficile test, an on-demand molecular diagnostic test designed for 45-minute detection of the bacterium that causes Clostridium difficile infection or CDI.

The Xpert C. difficile test is the first test for CDI to deliver both rapid turnaround and a high degree of accuracy, the company said.

"The previous lack of an accurate and rapid diagnostic test for CDI has greatly impeded our ability to halt the increasing rate of CDI, which has taken a severe turn in the past several years. Patients can have their first diarrhea symptoms on a Monday and be dead by Thursday," said Dale Gerding, MD, professor of medicine, division of infectious diseases, Loyola's Chicago Stritch School of Medicine.

C. difficile, a spore-forming bacterium, is now challenging Methicillin-resistant Staphylococcus aureus (MRSA) as the most prevalent Healthcare Associated Infection (HAI) in the United States. A recent study published by the Association for Professionals in Infection Control and Epidemiology (APIC) found that on any given day there are more than 7,000 patients in the United States suffering from CDI, causing the deaths of approximately 300 patients per day. The disease, which can range in severity from mild to severe diarrhea, pseudomembranous colitis, toxic megacolon, sepsis, and death, is costing American healthcare institutions up to $51.5 million per day.

Based in Sunnyvale, Calif., Cepheid (Nasdaq: CPHD) is an on-demand molecular diagnostics company that develops, manufactures, and markets fully-integrated systems and tests for genetic analysis in the clinical, industrial and biothreat markets.

Read more in the company's press release.

Safety Labels To Carry Risk Warnings About Clostridium difficile

C. difficile Lawyer — Sun, 05 Jul 2009 12:01:23 -0800

Medscape, the online medical newsletter from WebMD, is reporting on recent safety labeling changes to give the public more information about Clostridium difficile.

“The US Food and Drug Administration (FDA) has approved safety labeling revisions to advise of an interaction between amoxicillin and certain urine glucose tests, and to include patient information regarding the risk for the development of Clostridium difficile–associated diarrhea more than 2 months after completion of treatment with a prepackaged regimen of lansoprazole, amoxicillin, and clarithromycin tablets,” its reports.

“The agency also warned that amoxicillin, clarithromycin, and other antibiotics have been linked to a risk for Clostridium difficile–associated diarrhea (CDAD) that may range in severity from mild diarrhea to fatal colitis and occur more than 2 months after treatment is completed. Because hypertoxin-producing strains of C difficile can be refractory to antimicrobial therapy, they are associated with increased morbidity and mortality rates and may require colectomy."

Read the rest in Medscape.

Speaker To Address 8,324 C. diff Deaths In UK During 2007

C. difficile Lawyer — Wed, 24 Jun 2009 10:56:06 -0800

This just in from across the pond:

"In England and Wales, the national health statistics in 2007 showed that there were 8,324 death certificates which named Clostridium difficile. This is a bacterium which causes severe diarrhoea in humans and animals as the underlying cause of death, a 28 percent increase from 2006."

Janet Nale of the Department of Infection, Immunity and Inflammation has been investigating the contributing factors that make Clostridium difficile so aggressive to direct treatment.

She will present her research at the Festival of Postgraduate Research tomorrow on Thursday, June 25th in the Belvoir Suite, Charles Wilson Building at the University of Leicester between 11:30 am and 1 pm. This event is open to the public and is free to attend. We will be looking for what she has to say.

Alimentary Pharmabiotic Center Building Designer Bacteria To Fight C diff And Other Superbugs

Bill Marler — Wed, 10 Jun 2009 21:29:59 -0800

If there were a bully in the neighborhood, the Irish way to deal with the situation might be to find somebody bigger to knock him or her out. That appears to be the tack the University College Cork (UCC) is taking when it comes to the dangerous Clostridium difficile.

A UCC research team plans to fight hospital superbugs with designer bacteria that they hope will be tougher than Clostridium difficile.

In other words, the Irish researchers plan to conduct germ warfare against the very superbugs that are proving resistance to the world’s best antibiotics. They want to stop C difficile and the infamous MRSA.

The approach UCC’s Alimentary Pharmabiotic Centre (APC) is taking is to add extra genes to give their designer bacteria an edge over C difficile. The APC looks for “good bugs” in the most unexpected of places. Gut tissue samples recovered from consenting patients offer a ready supply, but so too does the contents of an infant’s nappy. “They are quite good sources for probiotics,” Dr. Roy Sleator told The Irish Times.

For more on germ warfare against the superbugs, check out the rest of the story in today's IT here.

C. Diff Claims the Lives of Two Elderly Scottish Patients

C. difficile Attorney — Thu, 14 May 2009 16:13:30 -0800

The BBC is reporting that two elderly patients suffering from Clostridium difficile have died at Dr. Grey's hospital in Moray, Scotland.

Six other patients at the hospital have contracted Clostridium difficile. Additionally, a higher than usual number of patients are suffering from gastrointestinal illnesses.

An outbreak control team has been set up.

The health board said the deaths happened in April and that both the patients had been frail.

A spokesman said the infection was the main cause of death in one of the patients and was a contributory factor in the second death.

Bulletproof Blog - C. diff Makes the List of " Looming Food Supply Crises"

C. difficile Attorney — Wed, 22 Apr 2009 10:46:27 -0800

I had a chance to chat with Larry Smith, who publishes the Bulletproof Blog. Each week Larry interviews top plaintiffs’ attorneys for their perspective on the crises likely to affect businesses in the near future. Here's how he described our interview:

In this issue, we talk to Bill Marler of the Seattle-based Marler Clark, LLP PS. He is the legal profession’s best-known advocate for plaintiffs in food-related cases and a major force for food safety in the U.S. During his career, Mr. Marler has secured nearly $500 million for his clients. He publishes widely and speaks on food safety around the world.

Here's where C. diff came up:

Larry Smith: Are there specific products that you now have your eye on?

Bill Marler: It’s hard for anyone to predict the next crisis because we’re talking about ever-morphing pathogens. I have nothing but empathy for responsible companies challenged to somehow predict the next bacterium and where it’s going to strike. To cite just a couple of danger zones, pork products face increased risk of Methicillin-resistant Staphyloccus aureus (MRSA) bacteria and, as we effectively control Salmonella, we create opportunites for Clostridium difficile (C-dif) bacteria to proliferate in our guts. It’s a deadly threat to the elderly.

The entire interview can be read here.

Clostridium difficile in Food -Is This the Next Thing to Keep us Up at Night?

C. difficile Attorney — Fri, 17 Apr 2009 10:30:10 -0800

You would think we'd have enough pathogens to lose sleep over, but it seems that there is at least one more to add to the midnight pantheon. Over the last several years we have seen multiple instances where Clostridium difficile and foodborne illness have been related. However, the Clostridium difficile infection has generally been associated with the foodborne illness after treatment for the infection by antibiotics, not as a result of actual ingestion of the Clostridium difficile bacteria. However, in the recent Salmonella Typhimurium Peanut Butter outbreak, we have two cases where children seem to be co-infected with both Clostridium difficile and Salmonella Typhimurium. Which brings us to the the important question – Is Clostridium difficile foodborne?

For background, Wikipedia reports that Clostridium difficile is a species of Gram-positive bacteria of the genus Clostridium. Clostridia are anaerobic, spore-forming rods (bacillus). C. difficile is the most serious cause of antibiotic-associated diarrhea (AAD) and can lead to pseudomembranous colitis, a severe infection of the colon, often resulting from eradication of the normal gut flora by antibiotics. The C. difficile bacteria, which naturally reside in the body, become overgrown: The overgrowth is harmful because the bacterium releases toxins that can cause bloating, constipation, and diarrhea with abdominal pain, which may become severe.

The CDC reports that mortality rates from Clostridium difficile disease in the United States increased from 5.7 per million population in 1999 to 23.7 per million in 2004. Increased rates may be due to emergence of a highly virulent strain of C. difficile.

Here are a few articles that I have found or have been sent on the topic. Clearly more research needs to be done.

Possible Seasonality of Clostridium difficile in Retail Meat, Canada (pdf)

Rodriguez-Palacios A, Reid-Smith RJ, Staempfli HR, Diagnault D, Janecko N, Avery BP et al. Possible seasonality of Clostridium difficle in retail meat, Canada. Emerg Infect Dis. 2009 May

We previously reported Clostridium difficile in 20% of retail meat in Canada, which raised concerns about potential foodborne transmissibility. Here, we studied the genetic diversity of C. difficile in retail meats, using a broad Canadian sampling infrastructure and 3 culture methods. We found 6.1% prevalence and indications of possible seasonality (highest prevalence in winter).

Clostridium difficile in Retail Meat Products, USA, 2007 (pdf)

Songer JG, Trinh HT, Killgore GE, Thompson AD, McDonald LC, Limbago BM. Clostridium difficile in retail meat products, USA, 2007. Emerg Infect Dis. 2009 May

To determine the presence of Clostridium difficile, we sampled cooked and uncooked meat products sold in Tucson, Arizona. Forty-two percent contained toxigenic C. difficile strains (either ribotype 078/toxinotype V [73%] or 027/toxinotype III [NAP1 or NAP1-related; 27%]). These findings indicate that food products may play a role in interspecies C. difficile transmission.

Clostridium difficile in Ready-to-Eat Salads, Scotland (pdf)

Bakri MM, Brown DJ, Butcher JP, Sutherland AD. Clostridium difficile in ready-to-eat salads, Scotland. Emerg Infect Dis. 2009 May

Of 40 ready-to-eat salads, 3 (7.5%) were positive for Clostridium difficile by PCR. Two isolates were PCR ribotype 017 (toxin A–, B+), and 1 was PCR ribotype 001. Isolates were susceptible to vancomycin and metronidazole but variably resistant to other antimicrobial drugs. Ready-to-eat salads may be potential sources for virulent C. difficile.

40 Percent of Grocery Store Meat Sampled has Superbug Clostridium difficile (C. diff)

C. difficile Lawyer — Tue, 18 Nov 2008 03:04:23 -0800

A potentially deadly intestinal germ increasingly found n hospitals is also showing up in a more unsavory setting: grocery store meats. According to press reports this morning, an Arizona researcher found that a shocking forty percent of tested meat products were contaminated with Clostridium difficile, a bacteria normally associated with severe hospital infections. The test was conducted on meat from three national chain stores. Federal health officials, however, say more study is needed to determine whether C. diff is transmitted through food.

More than 40 percent of packaged meats sampled from three Arizona chain stores tested positive for C. diff., according to newly complete analysis of 2006 data collected by a University of Arizona scientist. Nearly 30 percent of the contaminated samples of ground beef, pork and turkey and ready-to-eat meats like summer sausage were identical or closely related to a super-toxic strain of C. diff blamed for growing rates of illness and death in the U.S. — raising the possibility that the bacterial infections may be transmitted through food.

About C. difficile

C. difficile Attorney — Sat, 01 Mar 2008 15:50:24 -0800

Overview

Clostridium difficile (C. difficile) is a spore-forming, gram-positive anaerobic bacillus that produces two toxins: toxin A and toxin B. These toxins typically cause gastrointestinal disease, often with severe complications. In rare cases, C. difficile-associated disease can be fatal. Although C. difficile bacteria can be present in human intestinal tracts and cause no clinical symptoms (a condition called colonization), some individuals with C. difficile colonization are at increased risk of becoming ill. The most common risk factor for C. difficile-associated disease is exposure to antibiotics, especially those with broad-spectrum activity. Although less common, exposure to agents that suppress the immune system may also increase the risk of illness. Advanced age, severe underlying illness, gastrointestinal surgery, use of nasogastric tubes, and gastrointestinal medications (such as gastrointestinal stimulants or antacids) have also been associated with an increased risk of colonization. Most cases are acquired in hospitals or nursing homes, but an increased incidence of community–acquired C. difficile has been reported as well. Recent studies indicate that C. difficile can also be found in food products, thus raising a significant question: Can C. difficile cause foodborne illness?

Sources and Transmission

C. difficile is shed in feces. Any material, device, or surface that becomes contaminated with feces—such as toilets or bathing tubs—may serve as a reservoir for C. difficile spores. The ability of C. difficile to form spores is thought to be a key feature that enables the bacteria to persist in patients and the physical environment for long periods of time, thereby facilitating its transmission.

The spores are transferred to patients in healthcare settings mainly through the hands of healthcare personnel who have touched a contaminated surface or item. Some evidence suggests that C. difficile may be brought into healthcare environments by asymptomatic carriers—otherwise healthy individuals with no apparent symptoms. Virulent strains, which cause severe disease in populations at high risk, might also cause more frequent, severe disease in populations previously at low risk—that is, in otherwise healthy persons with little or no exposure to health-care settings or antimicrobial use. Certain emerging features of C. difficile illness, such as close-contact transmission, high recurrence rate, young patient age, bloody diarrhea, and lack of antimicrobial exposure, might indicate that the illness and its effects are changing.

C. difficile has also been linked to illness in livestock. Studies have revealed high infection rates of C. difficile among neonatal pigs. Similarly, C. difficile has been implicated as a cause of diarrhea in calves. Livestock contamination raises concerns that the bacteria may make its way into retail food products. Indeed, C. difficile has been identified in raw meat intended for pet consumption in Canada, retail ground beef in Canada, and uncooked and ready-to-eat meats in retail markets in a U.S. metropolitan area.

The detection of the North American pulsed-field gel electrophoresis type 1 (NAP1) strain of C. difficile in retail ground beef is cause for concern. This hyper-toxin-producing strain has been a cause of serious outbreaks of healthcare-associated disease in humans in North America and Europe, and was found among a small subset of specimens from community acquired cases in Connecticut. C. difficile in retail meats may derive from a number of sources, including deposition of spores in animal muscle or other tissues, fecal or environmental contamination of carcasses, or contamination during processing or in retail meat markets. C. difficile also has been identified in ready-to-eat salads in Scotland, which may have resulted from environmental contamination or transmission by food handlers.

These studies highlight the potential for transmission through the food supply, but do not prove that transmission of C. difficile can occur from food to humans. In fact, no instances of foodborne illness associated with C. difficile have been reported to date. Further research is necessary to explore the feasibility of this route of transmission.

Symptoms

The incubation period from ingestion of C. difficile to the development of symptoms has not been established. Among patients taking antibiotics, symptoms can appear immediately after beginning treatment or may not develop until several weeks after it is completed.

Most often, C. difficile-associated disease includes symptoms of mild to moderate non-bloody diarrhea, sometimes accompanied by lower abdominal cramping. Systemic symptoms, such as fever, are typically absent; mild abdominal tenderness is usually the only finding on physical exam.

In more severe cases, colitis develops, with symptoms of profuse watery diarrhea and abdominal pain and distention; bloody stools are rare. Fever, nausea, and dehydration are also often present in severe cases. Furthermore, a characteristic membrane with adherent yellow plaques can be found in the colon. Patients with severe colitis are at increased risk of developing paralytic ileus (blocked colon due to lack of peristalsis―the normal rhythmic contraction of the colon muscles) and toxic megacolon (dilated colon). These conditions may lead to a decrease in diarrhea. Severe cases may also include fulminant colitis―a rapid downhill clinical course that occurs among 1% to 3% of patients. Patients may have an acute abdomen and systemic symptoms, such as fever and tachycardia, and may require surgery.

Mortality rates associated with C. difficile-related disease in the U.S. increased nearly three-fold from 1999 to 2002. A recent study, which included C. difficile-related cases where C. difficile infection was present but not listed as the underlying cause of death, demonstrated an increase in deaths from 5.7 per million population in 1999 to 23.7 per million in 2004. It is possible that the increased rates were due to the emergence of a highly virulent strain of C. difficile.

Detection

Stool cultures are the most sensitive means available to detect C. difficile, however, they are also the test most often associated with false-positive results, due to presence of non-toxigenic bacterial strains. C. difficile stool cultures are also labor intensive and require the appropriate culture environment to grow anaerobic microorganisms. Results are available within 48 to 96 hours of the test.

Antigen detection tests for C. difficile have a very fast turn around time (less than one hour); these tests detect the presence of C. difficile antigen by latex agglutination or immunochromatographic assays. Antigen tests must be combined with toxin testing to verify diagnosis. One type of antigen test, enzyme immunoassay, detects toxin A, toxin B, or both A and B. It is a same-day assay but is less sensitive than the tissue culture cytotoxicity assay. The tissue culture cytotoxicity assay detects toxin B only. This assay requires technical expertise, is costly, and requires 24 to 48 hours for a final result. It does, however, provide specific and sensitive results for C. difficile-associated disease.

It is important to note that C. difficile toxin is very unstable. The toxin degrades at room temperature and may be undetectable within two hours after collection of a stool specimen. False-negative results occur when specimens are not promptly tested or kept refrigerated until testing can be completed.

Treatment

C. difficile-associated disease will resolve in one-quarter of antibiotic-related cases within two to three days of discontinuing the problematic antibiotic. The infection can usually be treated with an appropriate course (about ten days) of antibiotics, including metronidazole or vancomycin (administered orally). Following treatment, repeat testing is not recommended if the individual’s symptoms have resolved, due to the fact that many patients remain colonized. In high risk individuals, recurrence of infection or relapse may occur after treatment.

Prevention

C. difficile-associated disease can be prevented in healthcare settings by using antibiotics judiciously and using contact precautions such as isolation, hand hygiene, and gloves and gowns with patients with known or suspected infection.

To ensure prevention, healthcare institutions should implement an environmental cleaning and disinfection strategy, especially for items likely to be contaminated with feces and surfaces that are touched frequently. These institutions should use an Environmental Protection Agency (EPA)-registered hypochlorite-based disinfectant for environmental surface disinfection after normal cleaning, making sure to follow the label instructions. Generic sources of hypochlorite (such as household chlorine bleach) may also be appropriately diluted and used. Alcohol-based disinfectants, however, are not effective against C. difficile and should not be used to disinfect environmental surfaces. Institutions should also follow the manufacturer’s instructions for disinfection of endoscopes and other devices. Infection control practices in long-term care and home health settings are similar to those practices recommended for traditional health-care settings.

Note: EPA-registered hospital disinfectants are recommended for general use whenever possible in patient-care areas. At present there are no EPA-registered products with specific claims for inactivating C. difficile spores, but there are a number of registered products that contain hypochlorite. If an EPA-registered proprietary hypochlorite product is used, consult the label instructions for proper and safe use conditions.

C. difficile in Ready-to-Eat Salads, Scotland

A 2008 study of ready-to-eat salads in Glasgow, Scotland found C. difficile in three (7.5%) out of forty salad samples. Samples were collected from packaged, ready-to-eat salads purchased from seven Glasgow supermarkets from May 1 through June 30, 2008. The majority (87.5%) of the salads were imported from European Union countries, and it was among those salads that the organism was found.

The specific C. difficile strains found in the salads were 001 (a common clinical isolate in Scotland) and 017 (a common European strain, negative for toxin A and positive for toxin B). None of the isolates were resistant to vancomycin or metronidazole, which is consistent with findings from other C. difficile isolates found in Scotland. Recent studies have, however, highlighted the emergence of increased resistance to metronidazole among C. difficile isolates in England.

The findings of these isolates from ready-to-eat salads highlights the potential risk associated with consuming these products, particularly since they are not cooked prior to eating. The consumption of these foods by vulnerable populations could possibly lead to C. difficile colonization and an increase in the asymptomatic C. difficile carriage rate among humans. This could result in an increase in C. difficile transmission within the community at large and in the healthcare environment. Nevertheless, as previously noted, no cases of foodborne illness linked to C. difficile have been reported.

C. difficile in Retail Meat Products, USA, 2007

In a 2007 study, packaged meats were purchased from three national-chain grocery stores in the Tucson, Arizona area. The meat products were purchased on three occasions, at one-month intervals, over a four-month period. Sampled products included both uncooked (ground beef, ground pork, ground turkey, pork sausage, and pork chorizo) and ready to eat meats (beef summer sausage, pork braunschweiger). The pork chorizo product was produced and distributed locally; all other samples were national brands. To ensure that a range of product was tested, products with different sell-by dates (a surrogate for production date) were sampled for each meat type. Samples were not, however, representative of all meat products within each grocery store.

C. difficile was found in 37 (42.0%) of 88 retail meats, including 42.4% of beef, 41.3% of pork, and 44.4% of turkey products. Ready-to-eat products were more commonly culture positive (11 out of 23, or 47.8%) than were uncooked meats (26 out of 65, or 40.0%), although the difference was not statistically significant. The highest percentages of C. difficile isolates were recovered from pork braunschweiger (62.5%) and ground beef (50.0%). No particular association of contamination was found with the meat processor, the sell-by date, the store, or the month sampled.

Approximately one-fourth of the C. difficile isolates were comprised of the 027/TT III strain, which was previously described almost exclusively in the context of the current human epidemic strain. Three-fourths of the isolates were comprised of the 078/TT V strain. Until recently, the 078 strain had been an uncommon cause of healthcare-associated C. difficile-associated disease in humans, but it is now emerging in pigs and calves with diarrhea and in persons with C. difficile-associated disease.

This study, as well as a previous study in Canada that found C. difficile in retail ground meat, raises concerns about the potential for foodborne transmission, even though they do not prove transmission of C. difficile from foods to humans. They do, however, highlight the need for further studies to characterize the risks posed by this organism in the human food supply.

References

Centers for Disease Control and Prevention (CDC). Surveillance for community-associated Clostridium difficile--Connecticut, 2006. MMWR Morb Mortal Wkly Rep. 2008;57(13):340-3.

Centers for Disease Control and Prevention (CDC). Severe Clostridium difficile-associated disease in populations previously at low risk--four states, 2005. MMWR Morb Mortal Wkly Rep. 2005;54(47):1201-5.

Jhung MA, Thompson AD, Killgore GE, Zukowski WE, Songer G, Warny M, Johnson S, Gerding DN, McDonald LC, Limbago BM. Toxinotype V Clostridium difficile in humans and food animals. Emerg Infect Dis. 2008;14(7):1039-45.

Poutanen SM, Simor AE. Clostridium difficile-associated diarrhea in adults. CMAJ. 2004;171(1):51-8.

Rodriguez-Palacios A, Staempfli HR, Duffield T, Weese JS. Clostridium difficile in retail ground meat, Canada. Emerg Infect Dis. 2007;13(3):485-7.

Rupnik M. Is Clostridium difficile-associated infection a potentially zoonotic and foodborne disease?. Clin Microbiol Infect. 2007;13(5):457-9.

Songer JG, Trinh HT, Killgore GE, Thompson AD, McDonald LC, Limbago BM. Clostridium difficile in retail meat products, USA, 2007. Emerg Infect Dis. 2009;15(5):819-21.

Sunenshine RH, McDonald LC. Clostridium difficile-associated disease: new challenges from an established pathogen. Cleve Clin J Med. 2006;73(2):187-97.

See also the Centers for Disease Control and Prevention website on C. difficile infections: http://www.cdc.gov/ncidod/dhqp/id_Cdiff.html

Outbreak of C. difficile claims 10 lives in Canada

C. difficile Attorney — Thu, 02 Nov 2006 11:24:10 -0800

An outbreak of C. difficile at a Quebec hospital in St-Hyacinthe has killed another person, bringing the death toll to 10 since the bacteria emerged at the health centre in July.

A total of 25 people have been infected with C. difficile, which causes severe diarrhea, at the Centre hospitalier Honoré-Mercier in St-Hyacinthe, an agricultural town southeast of Montreal.

The hospital announced in late October that it had introduced several measures to contain the infection, including restricted visiting rules and a massive disinfection campaign.

More information can be found in this article.