Thanks to modern medical practices and improved sanitation, Canadian hospitals are well equipped to handle infection, manage the risk of complications post-surgery, and promote general cleanliness. Despite this, many patients still fear the risks associated with surgery. For those who have inflammatory bowel disease (IBD), and therefore may be more likely to undergo disease-related surgeries, the potential of a hospital-acquired Clostridium difficile infection (CDI) remains a concern.

 

CDI Statistics

Clostridium difficile (C. difficile) is a spore-forming bacterium present in soil, human feces, and in environments that sick or vulnerable individuals are more likely to be exposed to, such as hospitals, nursing homes, and child-care facilities. CDI occurs when illness or medication disrupts the normal balance of bacteria within the colon, allowing C. difficile bacteria to overgrow and cause illness. A compromised immune system, gastric acid suppression medications, and antibiotics all have the potential to increase the risk of infection, which can cause symptoms such as intense diarrhea, fever, nausea, and even fatal inflammation of the colon.

CDI is rare, with an incidence of healthcare-associated cases estimated at 5.35 per 1,000 patient admissions in Canada in 2011.1 However, it is more common in the elderly and in those with IBD, as they may have compromised immune systems and/or a higher likelihood of requiring surgery. Both Crohn’s disease and ulcerative colitis, the two most common forms of IBD, occur due to inflammation in the digestive tract, although the location of this inflammation varies between the two diseases. If an IBD patient’s inflammation becomes severe and other forms of treatment are unsuccessful, then removal of part of or the entire colon (colectomy) might be necessary.

In addition to the devastating symptoms of the infection, it might also increase an individual’s risk of requiring colectomy. Since Canada has one of the highest rates of IBD in the world, it is important to control the risk of CDI outbreaks so that people with IBD are not affected in the long term. However, this is easier said than done.

In 2002, the Centre Hospitalier Universitaire de Sherbrooke in Quebec reported that there were 2.1 cases of CDI per 1,000 patients admitted, a figure that increased in 2003 to 10 cases per 1,000 patients admitted. The number of C. difficile-infected patients would again rise in 2004, to 18 cases per 1,000 admitted.2 To help manage the risk of outbreaks, in 2009, the Public Health Agency of Canada (PHAC) made C. difficile a notifiable disease within the Canadian Notifiable Disease Surveillance System. With this system, Canadian hospitals can report confirmed cases of CDI to the PHAC and work with them to control and minimize future infection.3

 

Recent Data

To better understand the short- and long-term risks associated with CDI and colectomy, researchers from The Ottawa Hospital and from the Mayo Clinic in Minnesota recently reviewed 12 observational studies to assess if CDI puts IBD patients at risk for a colectomy, compared to IBD patients who do not have CDI. Researchers examined the data of 35,057 IBD patients who also had CDI and 929,259 IBD patients who did not have CDI, collected from 1998 to 2013 within North America, Europe, and Asia.

The researchers determined that the risk of colectomy in patients with CDI seemed to increase in the long-term (at least one year or longer from the time of CDI diagnosis) but not in the short-term (within three months from the time of CDI diagnosis).4

Although the analysis could not determine the potential reasons for greater long-term colectomy risk in patients with CDI, it did help to identify the demographic of those who could be affected by complications associated with the infection.

 

Outlook

As we now know, the most effective way to combat infections such as CDI is by practicing proper hand washing, using chlorine-based cleaning products to disinfect, and encouraging others to do the same. By doing so, we can all work to decrease the risk of CDI and other communicable illnesses and protect those who are at a greater risk of contracting them. Additionally, it is important to remember that while the use of certain antibiotics can increase a person’s risk for C. difficile infection, they are sometimes necessary to combat other serious infections. In fact, certain types of antibiotics are used to treat CDI. It is important for those with compromised immune systems, those taking antibiotics, and those who are recovering from surgery to be mindful of any symptoms they experience and look to their health care providers for guidance.


First published in the Inside Tract® newsletter issue 203 – 2017
1. Public Health Agency of Canada. The Canadian Nosocomial Infection Surveillance Program. Available at: http://www.phac-aspc.gc.ca/nois-sinp/projects/cdad-eng.php. Accessed 2017-06-21.
2. Valiquette L, et al. Clostridium difficile infection in hospitals: a brewing storm. Canadian Medical Association Journal 2004;Jul;171(1):27-9.
3. Government of Canada. Fact Sheet – Clostridium difficile (C. difficile). Available at https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html. Accessed 2017-09-08.
4. Law C. C. Y., et al. Systematic review with meta-analysis: the impact of Clostridium difficile infection on the short- and long-term risks of colectomy in inflammatory bowel disease. Alimentary Pharmacology and Therapeutics. 2017; 45: 1011-1020.