What You Should Know About the "Difficult Infection"

By Dr. W. Gifford Jones

February 9, 2003

John Dillinger, the notorious bank robber, was asked why he robbed banks. He logically replied, "It's where the money is". Today if you asked infection control specialists where many infections are, they would say, "It's in the hospitals". Hospitals can be dangerous places. You can occasionally, be given the wrong medication or have the wrong leg amputated. But more commonly, patients acquire a debilitating and sometimes serious hospital infection called Clostridium difficile. How do you become infected and how can it be prevented?

A report in the Journal of the Canadian Medical Association states that C. difficile associated diarrhea (CDAD) is now the leading cause of diarrhea in hospital patients. It suggests that CDAD infection should be suspected if patients with diarrhea have received an antibiotic during the previous two months or 72 hours after hospitalization.

We all have millions of bacteria living in our large bowel, usually at peace with one another. And studies show that about 3 percent of adults and 70 per cent of healthy infants have C. difficile present in their intestines. But when antibiotics are given to treat pneumonia, ear, bladder or sinusitis infections this often upsets the balance of power, allowing C. difficile to increase and produce toxins causing diarrhea. It's what would happen if hunters killed all the wolves and allowed the deer to multiply.

The majority of patients complain of fever, loss of appetite, abdominal pain and watery or bloody diarrhea, passing as many as eight or more foul-smelling stools a day. In serious cases the large intestine may become so severely inflamed and distended that there's a danger the colon may rupture. In one study 13.8 percent of patients died within 30 days of acquiring the infection.

C. difficile is not a rare problem. A report in the Journal, Pediatric Pharmacotherapy, claims that 15 to 20 percent of patients receiving antibiotics develop antibiotic associated diarrhea. Another report from The Mayo Clinic says that every year three million North Americans develop C. difficile infections.

The diagnosis is made by examining a stool sample to detect either the presence of C. difficile or its toxin.

The treatment in most cases is to discontinue the offending antibiotic which allows normal bacteria in the bowel to recover. This approach is successful in about 25 percent of cases. However, patients with serious infections may initially require drugs such as metronidazole to fight C. difficile. Unfortunately 10 to 20 percent of patients have recurrent diarrhea and need additional treatments with other medication since it's hard to completely eradicate C. difficile.

John Dillinger avoided capture many times because he used prevention tactics. The same rule apples to CADA. There would be fewer cases of C. difficile if doctors used fewer antibiotics for questionable reasons. Patients should also warn their physician if they have previously suffered from diarrhea following antibiotic use.

Remember, when buying real estate, the key words are location, location, location. In this case it's hygiene, hygiene, hygiene. C. difficile is a difficult germ to eradicate and easily picked up from faulty habits. Infection occurs when contaminated fecal matter reaches the mouth.

One study showed that wheelchairs, bedrails, counter tops and toilet seats were often contaminated by this infection. These objects must be sanitized using a quarter of a cup of bleach to one gallon of water.

Another study revealed that 28 percent of health care workers who touched a patient suffering from C. difficile had this germ on their hands. So you don't have to be a nuclear physicist to conclude that proper hand hygiene is one key to preventing CADA and other diseases.

Frequent use of soap and water is always a sound hygienic measure. A number of antibiotic skin cleansers are also available. We always keep a bottle of Trisan at the kitchen sink and bathroom counter as it has both antibiotic and moisturizing properties to prevent drying of the skin.

The bad news is that studies show that only 40 percent of people wash their hands after visiting the washroom. John Dillinger wouldn't take that risk and neither should you.

Trisan is available in most pharmacies. For more information on this product call the toll-free number 1-800-465-8383.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones

Canada Free Press, CFP Editor Judi McLeod