"We believe drugs that reduce gastric acidity provide a more hospitable environment within which C. difficile bacteria can colonize," says MUHC researcher and lead author of the new study Dr. Sandra Dial. Numerous studies worldwide have documented increases in hospital C. difficile associated disease, but this study is the first to suggest this trend is mirrored in the general community. Dr. Sandra Dial is Attending Staff in the Department of Critical Care at both the MUHC and Jewish General Hospital (JGH) and an Assistant Professor of Medicine at McGill University.
Using data from the United Kingdom General Practice Research Database (GPRD), researchers traced variation in community C. difficile associated disease over a 10-year period. "In 1994 there was less than one C. difficile case per 100,000 people in the database," says Dr. Dial. "By 2004, this number had increased exponentially to 22 cases to per 100,000." It is important to note however, that community rates are still much lower than hospitals overall.
A surprising discovery in the study was that over 70% of the patients who developed C. difficile associated disease had not been admitted to hospital in the past year, and that less than 50% had taken antibiotics in the three months prior to developing disease. "This is noteworthy because unlike previous beliefs it is now evident that C. difficile disease has left the hospital setting to reach the community and that antibiotics are not the only culprit," says senior author of the study Dr. Samy Suissa, Director of the Division of Clinical Epidemiology at the MUHC and James McGill Professor of Epidemiology, Biostatistics and Medicine at McGill University.
This discovery follows on the heels of an announcement last week that researchers from the MUHC and JGH have sequenced the Quebec strain of C. difficile. McGill and its affiliated hospitals will continue to take a leading role in C. difficile research in order to improve treatments and prevention techniques, as well as develop more rapid diagnosis for an infection that has become a serious health concern, not just in Quebec but around the world.
This research was funded by the Canadian Institutes of Health Research (CHIR), the Canadian Foundation for Innovation (CFI) and the Fonds de la recherché en santé du Québec (FRSQ). Dr Suissa is the recipient of a Distinguished Scientist award from the CIHR.
About Clostridium difficile
Clostridium difficile, also known as C. difficile, is a bacterial microbe that can cause an infection of the bowel. The usual symptoms are diarrhea, fever and abdominal pain. Quebec-based research indicates that the most common C. difficile strain in Quebec is similar to others found in the US and Europe. The Quebec strain is resistant to a group of antibiotics called fluoroquinolones, which may have contributed to its spread through the province. Regular hand washing with soap and water is the mainstay of prevention of C. difficile infection.
About the McGill University Health Centre (MUHC)
The MUHC is a comprehensive academic health institution with an international reputation for excellence in clinical programs, research and teaching. The MUHC is a merger of five teaching hospitals affiliated with the Faculty of Medicine at McGill University, the Montreal Children's, Montreal General, Royal Victoria, and Montreal Neurological Hospitals, as well as the Montreal Chest Institute. Building on the tradition of medical leadership of the founding hospitals, the goal of the MUHC is to provide patient care based on the most advanced knowledge in the health care field, and to contribute to the development of new knowledge.
Journal
JAMA