Clostridium difficile: How Worried Should We Be?

By Erik L. Goldman | Editor in Chief - Vol. 11, No. 2. Summer, 2010

Clostridium difficile has surpassed methicillin-resistant Staphylococcus aureus (MRSA) as Microbial Enemy No. 1 in America's hospitals. Officials are urging community-based physicians to be increasingly vigilant for this sometimes-deadly infection, and extremely judicious in their use of antibiotics. Overuse of antibiotics is a main driver of the epidemic.

Microbial Enemy No. 1:  Transmission electron micrograph of C. difficile forming an endospore (red oval). C. difficile, a Gram-positive anaerobic bacillus, exists in small numbers in the human gut, but proliferates rapidly when intestinal resistance is low, producing a toxin that causes diarrhea. In severe cases, it can cause fatal pseudomembranous colitis. Disease is almost always associated with antibiotic use. Incidence of C. difficile recently surpassed MRSA in US hospitals. New strains are more virulent, effect younger people, and show increased antibiotic resistance. Magniꐀcation: x18,000.Credit: Dr. Kari Lounatmaa / Copyright 2010 Photo Researchers, Inc. All rights reserved.

According to the Centers for Disease Control, states all across the country are reporting increased rates of C. difficile infection, as well as increased severity and mortality. The people at greatest risk remain the elderly, especially those using antibiotics. But the surveillance data suggest the bug is extending beyond its usual target demographics—the old, the infirm and the institutionalized—and striking people previously considered low-risk: reproductive age women, children and generally "healthy" people.

This spring, Dr. Becky Miller and her team at Duke University reported that for the first time, prevalence of C. difficile topped that of MRSA in US medical centers. The latter "superbug," though still a major cause for concern has been on the wane since 2005, while C. difficile has been on the rise.

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