Illegal immigrants from Mexico are responsible for Clostridium difficile related pseudomembranous colitis outbreaks. At least that's what people commenting on one article about an outbreak in one Arizona community are saying. Anyone who works in hospitals, especiallly hospitalists, know how ubiquitious clostridium difficile infections have become. Here are my take home points for Clostridium difficile infections
- It is a spore. It cannot be killed by alcohol wipes. You must use vigorous hand washing with soap and water to get it off your hands.
- It is transmitted by fecal-oral route. Wash your hands with soap and water.
- Millions of Americans have Clostridium difficile spores living in their bowels every day, causing no problems at all.
- If you take an antibiotic, pretty much any antibiotic, you risk wiping out your good bacterial flora (good bacteria) in your gut that keeps the c diff in check. It doesn't matter what antibiotic it is. I've seen this infection with them all. Clostridium difficile itself is not harmful. It is the toxin produced by this spore that attacks the lining of your bowel wall that can cause severe pseudomembranous colitis, or inflammation of your colon in rare cases require emergency surgical resection or it may even cause a rapid death.
- If you take antibiotics for any reason, I am recommending most of my patients also take a probiotic as well (such as Saccharomyces boulardii; aka Flurastor). Some studies suggest we must only treat around ten people with probiotics to prevent one case of c diff colitis. I avoid probiotics in people who have pancreatitis or are quite immune suppressed.
- I try to avoid the class of drugs called quinolones whenever I can. Specifically Levaquin. It seems like this antibiotic mutates or increases the risk of a deadlier strain taking over.
- If you got c diff colitis or diarrhea in the hospital, you most likely got it from being on antibiotics from your already colonized gut. You likely did not get it from a cluster outbreak and it's probably not the hospital's fault. I've been a hospitalist for seven years and I've never seen a local outbreak. Only many unrelated individual cases.
- Most cases of clostridium difficile infections are not caused by the classically associated drug clindamycin. You can read about the clindamycin clostridium difficile drama here by patients who lack understanding of the disease process (conments)
Everyone knows that illegal immigrants aren't responsible for allclostridium difficile infection, except in Arizona, where apparently they are responsible for everything.