A deadly bacterial infection commonly seen in older and severely ill patients who recently have taken antibiotics or were hospitalized is appearing more often in younger, healthier people without those traditional risk factors, federal health officials say.
The bacteria in question, Clostridium difficile, or C-diff, has been blamed for 100 deaths in 18 months at a Quebec hospital, according to a report in this week’s Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report.
C-diff, which is found in the colon, also affected at least 33 otherwise healthy Americans in four states during the past two years, killing one of them. The victims — in Pennsylvania, New Jersey, Ohio and New Hampshire — ranged in age from six months to 72 years, the report said.
“We think C-diff is much more widespread (than these findings indicate),” said Dr. L. Clifford McDonald, a CDC epidemiologist and author of the report. “It’s not a nationally reportable disease, and there is not a formalized surveillance.”
The person who died after being infected with C-diff was a 31-year-old Pennsylvania woman who was 14 weeks pregnant with twins. Despite being treated with antibiotics considered effective against the bacterium, the woman miscarried the fetuses and then died.
She was among 10 healthy women who were either pregnant or had just given birth when they were stricken with bowel problems after being infected with C-diff. These women had brief hospital stays before they became ill.
Another 23 severe cases of Clostridium difficile-associated disease (CDAD) were reported among healthy people in the Philadelphia area. None of those had been admitted to a hospital within three months of becoming sick, Dr. McDonald said.
Eight of the 33 CDAD patients said “they had not taken any antibiotics before becoming ill,” he added.
The bacteria can cause diarrhea and a more serious intestinal condition known as colitis.
C-diff is spread by spores in feces, and these spores are hard to kill with conventional household cleaners. It is resistant to certain antibiotics that have been shown effective against germs in the colon.
Five of the eight CDAD cases in which patients had not taken antibiotics beforehand involved children, three of whom required hospitalization. Three of the eight cases occurred as a result of close contact with someone with diarrheal illness. One woman transmitted C-diff to her child, who then spread it to a family friend.
“People need to keep their hands clean,” Dr. McDonald advised.
He said it has been known for years that an antibiotic known as clindamycin sharply increases the risk for CDAD. But the pregnant woman who died had taken a common antibiotic known as trimethoprim sulfamethoxazole three months earlier to treat a urinary tract infection.
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