For the purpose of this paper, infections from Clostridium difficile also known as C.diff or C.difficile has been chosen, as this is a bacterium which can cause a range of symptoms starting from mere diarrhea to that of fatal inflammation of the colon. Complications from the infection from C.diff is a common phenomenon which affects aged adults in hospitals or in different long term facilities of cares and has the highest chance of occurrence after usage of antibiotic medications. C.diff has been chosen as the Hospital-association –Infection (HAI) to focus on as the occurrence of individuals getting impacted from C.difficile is increasing every year, and the infections have become more difficult, severe and higher in frequency and tough to treat (Mayoclinic, 2018).
CDI like disease was primarily reported by Finney and Osler at the Johns Hopkins Hospital on 1892. The major signs and symptoms are significant diarrhoea, abdominal pain, fever, foul odour, recent antibiotic exposure etc. For children, the most common symptom has been diarrhoea for 2 or more days, loss of appetite, fever, abdominal pain etc. A severe infection from C.diff can also lead to inflammation of the colon and accompanied by no or very little diarrhoea.
Clostridium difficile is a spore-forming; gram-positive, anaerobic rod bacteria and this bacterium can exist as a normal part of the intestinal flora of individuals specifically in matured age adults, and maybe asymptomatically colonized. The infection – CDI, is a toxin-associated disease of the intestine. C.difficile can effectively colonize the gut if the gut microbiota is absent or altered. The patients who get exposed to these spores of the bacteria in the hospital environment or the healthcare workers, who get exposed, can develop the CDI post an antibiotic treatment if they cannot form sufficient antibodies in response to the pathogen’s toxins by the production of “anamnestic serum lgG”. The patients thus developing this specific immunological response become the asymptomatic carriers of the bacteria, and this condition seems to give them protection from CDI or reversal occurs to the un-colonized state (DePestel & Aronoff, 2013). The actual reasons to understand why and how this occurs is not researched enough and till date poorly understood.
Since the beginning of the 21st century, a rapid rise has been observed in the USA, Canada and Europe. North America alone witnessed a five times increase in the frequency of the whole population and approximate 8 times in the population of the elderly. As per a recent report published by US, 336,600 CDI related hospitalizations have been identified and this has been equivalent to almost 1 out of 100 of all hospital stays in 2009. Drastic epidemiological changes have been – septic shock, intestinal perforations, toxic mega-colons etc and rise in the failure of treatment with metronidazole and other factors were also observed (Bassetti, Villa, Pecori, Arzese, & Wilcox, 2015).
The typical risk factors have been the environment of the healthcare, elemental diet, antibiotic exposure and medications for acid suppressions. With time, new strains of C.diff are evolving and these hypervirulent ones are resistant to erythromycin and fluoroquinolones which were typically used to treat the disease. High levels of resistance have been reported in Europe. A large number of antibiotics have been observed to promote the germination of C.diff spores, growth of the vegetative cells and production of toxins (Vindigni & Surawicz, 2015).
The typical preventive measures include, following basic hygiene like hand washing, contact precautions, though cleaning with disinfectants and also certain lifestyle changes like, avoiding unnecessary usage of antibiotics (Mayoclinic, 2018). As per the surveillance data derived from CDC, the following are the rates of incidences of CDI
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CDC. (2018). Tracking Clostridium difficile Infection. Retrieved March 16, 2018, from CDC: https://www.cdc.gov/hai/organisms/cdiff/tracking-cdiff.html
DePestel, D., & Aronoff, M. (2013). Epidemiology of Clostridium difficile Infection. J Pharm Pract , 26 (5), 464 - 475.
Mayoclinic. (2018). C.difficile Infection. Retrieved March 16, 2018, from Mayoclinic: https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691
Vindigni, M., & Surawicz, M. (2015). C. difficile Infection: Changing Epidemiology and Management Paradigms. Clin Transl Gastroenterol , 6 (7), 99 - 121.
World Health Organization. (2018). Public Health Surveillance. Retrieved February 19, 2018, from World Health Organization: http://www.who.int/topics/public_health_surveillance/en/
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