Playing Host to the Difficult Clostridium

Since the turn of this century, Clostridium difficile has demanded increased attention as a result of steadily rising incidence and greater disease severity. Published data indicate a doubling in the number of reported cases of C difficile–associated disease (CDAD) in U.S. hospitals between 2000–2003.¹ In addition to this relentless increase in endemic CDAD, there have also been dramatic outbreaks in hospitals in the U.S., Canada, and Europe. These outbreaks have been characterized by twin demons, sudden large increases in disease incidence coupled with substantially increased disease severity and case fatality rates. In the recent Quebec outbreak, for example, a 4-fold increase in incidence and a 5-fold increase in case fatality rates resulted in a 20-fold overall excess in deaths attributed to CDAD.² Predictably, it is the elderly and the infirm who are most vulnerable to CDAD and most likely to succumb to fulminant and refractory disease. However, recent reports indicate that CDAD might now afflict individuals who were not previously considered to be at risk. Physicians are warned of an increase in community-acquired CDAD and cases in children, young women postpartum, individuals with no history of antibiotic use, and close contacts of CDAD patients.⁴