Effective prevention and control of the environmental spread of nosocomial infections remains a challenge. In recent years, the task has become even more difficult with the emergence of C difficile as a major hospital-acquired pathogen (Fawley WN, Parnell P, Verity P, Freeman J, Wilcox MH. Molecular epidemiology of endemic Clostridium difficile infection and the significance of subtypes of the United Kingdom epidemic strain [PCR ribotype 1]. J Clin Microbiol 2005;43:2685-96) because it represents a major health service burden, and outbreaks are very costly, affecting duration of stay and, finally, disrupting services and patient care (Wilcox MH, Cunniffe JG, Trundle C, Redpath C. Financial burden of hospital-acquired Clostridium difficile infection. J Hosp Infect 1996;34:23-30).
Infection with C difficile is becoming increasingly encountered in the hospital setting with rates of infection escalating dramatically in the past 10 years. Moreover, relapsing episodes are now occurring at a greater frequency, seen in roughly 20% of patients after the first episode escalating to 40% to 45% after the first recurrence and 60% after 2 episodes (McFarland LV, Surawicz CM, Greenberg RN, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. Most recurrences often occur within 2 to 10 days but may be delayed for weeks or months after discontinuation of treatment. There are a number of well-established risk factors for primary infection with C difficile including antimicrobial agents, specifically penicillins, cephalosporins, clindamycin, and quinolones. Furthermore, immunosupressed persons such as elderly patients, transplant patients, and those undergoing chemotherapy are also at increased risk for developing infection (Trudel JL. Clostridium difficile colitis. Clin Colon Surg 2007;20:13-7). In the case of recurrence, predisposing conditions that may increase risk include older age, kidney disease, antacid medications, and antibiotic usage (Surawicz CM. Reining in recurrent Clostridium difficile infection--who’s at risk? Gastroenterology 2009;136:1152-4). I tried to post this earlier but yahoo wouldn't allow it because it had the words, well, I guess I can't use the words here either or it won't post. ha. maybe re nal will work