This article is more than 5 years old. Information may no longer be current.

Clostridium difficile strain could become super bug to rival MRSA

Rates of this strain have been increasing recently; one new strain makes up to 23 times more toxins.

Add topic to email alerts

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

Subscribe

Added to email alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

Back to Healio

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Back to Healio

With increased reports of Clostridium difficile-associated diseases and deaths due to this bacterium, orthopedic surgeons need to keep abreast of information about its toxicity and possible antimicrobial resistance.

They also need to be familiar with the characteristics of its newest strain, which causes diarrhea. Some studies describe it as even more virulent than its predecessors, causing outbreaks and showing resistance to fluoroquinolone antibiotics.

Most importantly, the characteristics of this new C. difficile strain emphasize the need for strict infection-control practices in health care settings.

Seek advice, control infection

Anthony Berendt, BM, BCh, FRCP, who is at the U.K. National Health System’s Bone Infection Unit and is medical director of Nuffield Orthopaedic Centre, Oxford, England, told Orthopedics Today, “All physicians, including orthopedic surgeons, need to remain alert to the possibility [of C. difficile] in patients who develop diarrhea while on or following a course of antibiotics. Even very short courses of antibiotic as used for surgical prophylaxis can trigger an episode of C. difficile diarrhea.�

For suspected cases, he recommended the orthopedist initiate a discussion with the hospital’s infection control or infectious disease specialist. “The advent in some centers of an apparently more virulent strain of the bacterium increases the importance of taking appropriate advice and infection-control measures, and of ensuring that antibiotic use is always appropriate, given for the shortest time possible, and with the narrowest possible antimicrobial spectrum,� Berendt explained.

C. difficile was recently listed as the cause of death on 1748 death certificates in the United Kingdom, according to a September report in the London Times. The mutated form of the bacterium had, at the time, already resulted in thousands of deaths in the United States and Canada and in 2004 had led to infections in 44,000 U.K. patients, the article said.

Concern about the C. difficile super bug has grown exponentially in Great Britain, possibly taking the spotlight away from the also worrisome super bug methicillin-resistant Staphylococcus aureus or MRSA, the article said. The article cited 12 recent deaths at Stoke Mandeville Hospital that health officials attributed to the new strain.

Research results released

In early December, the U.S. Centers for Disease Control and Prevention (CDC) and the New England Journal of Medicine released reports on the new bacterial strain and supplied physicians with new information for preventing C. difficile infection in patients and further outbreaks.

The resistant strain in 187 samples that CDC researchers studied was BI/NAP1, which showed up in more than half the samples they analyzed. They found it was resistant to fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin.

Previously, only 14 of 6000 C. difficile isolates included this particular strain, the researchers noted.

Some researchers working in this area found the strain NAP1/027 to be particularly toxic, producing 16 times more toxin A and 23 times more toxin B than did control strains.

The reports now circulating about prevention methods suggest that using soap and water for hand washing may be a better defense against the new strain whenever there are outbreaks, since the alcohol found in hand sanitizers has been found ineffective against the germ.

For more information:

• Bartlett JG, Perl TM. The new Clostridium difficile - What does it mean? N Engl J Med. 2005:353;23:2503-2505.
• McDonald LC, Killgore GE, Thompson A, et al. An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J med. 2005;353:2433-2441.
• Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353:2442-2449.