CLOSTRIDIUM DIFFICILE, Clostridium difficile (C.difficile), a toxin producing, spore forming anaerobic bacillus causes both sporadic and epidemic nosocomial diarrhea. Illness may range from mild watery diarrhea to life-threatening colitis. An antecedent disruption of the normal colonic flora followed by exposure to a toxigenic strain of C. difficile are necessary first steps in the pathogenesis of disease. Diagnosis is based primarily on the detection of C. difficile toxin A or toxin B. First-line treatment is with oral metronidazole therapy. Treatment with oral vancomycin therapy should be reserved for patients who have contraindications or intolerance to metronidazole or who fail to respond to first-line therapy.

Earlier we were accousted with 'Two Studies Report New, Resistant Strain of Clostridium difficile'.

Two studies published in the December 8 issue of the New England Journal of Medicine report on a new, resistant strain of Clostridium difficile.

"C. difficile is a gram-positive, anaerobic, spore-forming bacillus that can cause pseudomembranous colitis and other C. difficile–associated diseases," write L. Clifford McDonald, MD, from the Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues. "Recent reports suggest that the rate and severity of C. difficile–associated disease in the United States are increasing and that the increase may be associated with the emergence of a new strain of C. difficile with increased virulence, resistance, or both."

"A previously uncommon strain of C. difficile with variations in toxin genes has become more resistant to fluoroquinolones and has emerged as a cause of geographically dispersed outbreaks of C. difficile–associated disease," the authors write. "The increasing use of fluoroquinolones in US health care facilities may have provided a selective advantage for this epidemic strain and promoted its widespread emergence.... If this epidemic strain continues to spread and to contribute to increased morbidity and mortality, it will be important either to reconsider the use of fluoroquinolones or to develop other innovative measures for controlling C. difficile–associated disease.

Recently, the genome of this super-bug has been decoded. It is anticipated that this decoding will help us understand the methods by which the bug derives its genetic variation that lends it its capacity to resist antibiotics.

How hospital bug can evade attack

Scientists have decoded the genetic make-up of a bacterium responsible for many hospital-acquired infections - and shown why it is so difficult to tackle.

Clostridium difficile caused more than 44,000 infections in the UK in 2004 - mostly among the elderly.

Researchers found it can chop and change its genetic structure very easily - maximising its ability to neutralise attack by antibiotics.

The Sanger Institute study is published in Nature Genetics.

Some of the measures under study for prevention of infection included use of Vinyl glove to 'interrrupt C.difficile transmission'.

Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission.
Johnson S, Gerding DN, Olson MM, Weiler MD, Hughes RA, Clabots CR, Peterson LR.
Department of Medicine, Veterans Administration Medical Center, Minneapolis, Minnesota 55417.

PURPOSE: Despite recognition that Clostridium difficile diarrhea/colitis is a nosocomial infection, the manner in which this organism is transmitted is still not clear. Hands of health care workers have been shown to be contaminated with C. difficile and suggested as a vehicle of transmission. Therefore, we conducted a controlled trial of the use of disposable vinyl gloves by hospital personnel for all body substance contact (prior to the institution of universal body substance precautions) to study its effect on the incidence of C. difficile disease.