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Friday, 8 July 2011

C. difficile outbreak - whatyou want to know and perhaps don't want to know

 Clostridium difficile is a bacteria that can cause a nasty diarrheal illness.  It is almost always associated with the use of antibiotics and almost always associated with hospitalization.

There have been numerous outbreaks in Canada and globally.  The Quebec health system was brought to its knees in 2003-04, at least 3 dozen people died from the infection however there are numbers that state this may have been closer to 100.   Related cases appeared globally in the subsequent few years.   Ontario in the Niagara area is now admitting ongoing outbreaks that have included deaths.  Check out the formal response at http://www.health.gov.on.ca/en/news/release/2011/jul/nr_20110707_1.aspx  

C. difficile tends to affect the most vulnerable in our society, usually those with illnesses already and often have complicated courses of care in hospital when the infection occurs.  It is a tragic consequence in situations that are often already tragic.  

But C. difficile is not a reportable infection.  Statistics are not collected in a consistent fashion, outbreaks, while they should legally be reported to local health units are often not reported by hospitals who have knowledge and expertise in managing the outbreaks.  At least until the outbreaks become the subject of public outcry and as one searches for reports, it is the public media reporting that tends to proceed the formal health systems reporting. 

Add to this is a subtle controversy in the background about the use of fecal transplantation as a mode of therapy for the disease. I don't have an opinion on the benefit or risk of the procedure, but certainly the suggestion invokes a gut reaction that perhaps has made the scientific investigation of the procedure less than rigorous.  

In the end we have a convergence of issues
1.   a bad infection that is associated with bad news
2.   less than transparency occuring for the public
3.   Science that debates the best way to prevent, manage and treat
4.   Controversial non-medical therapies that have a distinct following of knowledgeable medical professionals as well as their detractors.

it is a dirty little subject being treated as a dirty little secret.

Dr. P.

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