Tuesday, July 2, 2013

Nowhere to Hide From C. difficile: Study

Nowhere to Hide From C. difficile: Study

Jun 19, 2013
By Andrew M. Seaman
NEW YORK (Reuters Health) Jun 19 - Otherwise healthy people with Clostridium difficile may have acquired the infection in doctors' offices or other healthcare sites, according to a new government study that also hints proton pump inhibitors might increase the risk.
Researchers from the U.S. Centers for Disease Control and Prevention (CDC) found that about 82% of C. difficile cases in healthy people occurred after visiting healthcare settings.
"I think people should be aware of the source," said Dr. Fernanda Lessa, a medical epidemiologist in the surveillance branch of the division of healthcare quality promotion of the CDC and the study's senior author.
People typically acquire C. difficile during a hospital stay, especially after antibiotic therapy.
But C. difficile infection has been increasingly reported in young and healthy people who didn't stay in the hospital, Dr. Lessa and her colleagues write in JAMA Internal Medicine, adding that 20% to 28% of C. difficile cases are in healthy people.
In the current study, Dr. Lessa and her colleagues analyzed telephone interviews with 984 infected people in eight states from 2009 through mid-2011.
Overall, 18% hadn't made recent visits to a healthcare facility. The rest did report visiting doctors' or dentists' offices or even having been in a hospital for less than a day, such as for outpatient surgery.
About 64% of the infected people reported taking antibiotics during the previous 12 weeks. Those who took antibiotics were also more likely to have some sort of exposure to a healthcare facility.
Other possible sources of exposure to the bacteria are infected family members - especially babies, who can carry the bacteria without showing any symptoms.
The study participants who weren't exposed to a healthcare facility were also less likely to have taken antibiotics, but more of them were exposed to a third possible risk factor: proton-pump inhibitors.
Because previous research has tied proton-pump inhibitors to C. diff in healthy people, the U.S. Food and Drug Administration issued a warning about the association in February 2012, according to Dr. Kent Sepkowitz, writing in a commentary accompanying the new study.
"People should just be cautious about taking them willy-nilly. There are certainly people who need to take them, but then there are many who don't," said Dr. Sepkowitz, director of infection control at Memorial Sloan-Kettering Cancer Center in New York.
Dr. Peter Green from the Celiac Disease Center as Columbia University in New York said the drugs may create a hospitable environment for the C. diff bacteria to survive or - like antibiotics - they may disrupt the colon's "good" bacteria.
"It's very interesting because these proton-pump inhibitors are very widely used. People tend to get them and they just stay on them. Part of that is that they actually work to reduce heartburn symptoms," he said.
Dr. Green, who was not involved with the new study, said doctors are trying to get some people off the drugs because of their associations with C. diff, osteoporosis and other gastrointestinal infections.
"They're being used much more than is really necessary," he said.
Dr. Lessa cautioned, however, that it's not possible to draw firm conclusions from their study about what's causing the infections because it didn't compare the C. diff patients with a control group.
"The next step now is that we're undertaking a case-control study, enrolling patients without C. diff infections and test the hypotheses that were raised by this study," she said.
JAMA Intern Med 2013.

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