Canadian hospitals fight a rise in infections with Clostridium difficile
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《英国医生杂志》
Hospitals in Montreal and Calgary are fighting a rise in infections with Clostridium difficile, which has killed more people in the past 18 months than were killed by last year抯 outbreak of SARS (severe acute respiratory syndrome), a report in CMAJ, the Canadian Medical Association Journal, says.
The report appeared as an early release on the journal抯 website on 4 June (www.cmaj.ca/pdfs/171_1_news.pdf). "CMAJ抯 investigation has elicited reports of the deaths of at least 79 patients in several institutions, all of whom contracted the infection in 2003 or the first few months of 2004," says the journal. "By comparison, in all of Canada 44 people died from SARS during last year抯 outbreak in Ontario."
At least 12 Montreal hospitals have been trying to contain the outbreaks for 18 months. Calgary hospitals, which experienced a major outbreak in 2000-1 that later subsided, have seen a rising incidence of 13-15 new cases per 500 beds per month since last autumn. Dr Tom Louie, medical director of the Calgary health region抯 infection prevention and control, is said to have tracked 1167 patients with C difficile from 2001 to date. Infections resulted in 17 colectomies and 10 deaths.
But the journal report says the precise number of deaths and colectomies that occurred after patients contracted the organism in Montreal "is difficult to ascertain, because most of the hospitals CMAJ contacted would not release their individual statistics." A group of infectious disease specialists is now trying to determine the true extent of the problem and to develop strategies to contain it.
Doctors in Montreal disagree about how many deaths have occurred. Dr Sandra Dial, intensive care physician at the Montreal Chest Institute, claims 51 patients at Montreal抯 Royal Victoria Hospital alone died last year after contracting C difficile, with at least 30 of those deaths being directly attributable to the infection. But Dr Vivan Loo, director of infection prevention and control at the McGill University Health Centre, says that the number of people who have died as a direct result of the organism is probably closer to 15.
Doctors are also divided as to whether patients coming into hospital should be warned about the risks. Dr Dial believes that the health and hospital authorities should issue a public warning. The lack of such a statement was keeping patients from making the choice of delaying elective surgery or choosing to be admitted to a hospital with a low infection rates, she said.
But Dr Michael Libman, an assistant professor at McGill University and an authority on C difficile, does not think that the public needs a specific warning, although he does think they should be told that taking antibiotics can precipitate infection with C difficile and that they should be educated about the importance of handwashing.
"In any given day or month, things are going on in the hospital that affects the patient抯 risk. I don抰 know why we should be picking C difficile out of the multitude of risks to put emphasis on," he says. "It would be more frightening than anything else to take . . . low-risk elective patients and frighten them with numbers that probably have very little impact statistically on their cases."
C difficile is a common cause of infectious diarrhoea in industrialised countries and has been increasing in prevalence and severity. It occurs in some patients after they have taken prescribed antibiotics, and, once established in the intestine, it produces a toxin that damages the colon, which can be accompanied by haemorrhage. A total colectomy may be necessary. The organism forms spores that can survive for long periods outside the body and are resistant to common hospital disinfectants. It is spread by hand-to-hand contact.
Dr Todd McConnell, physician in chief at St Mary抯 Hospital, Montreal, calls C difficile "almost a pandemic" and "a huge concern to the medical community."(Quebec David Spurgeon)
The report appeared as an early release on the journal抯 website on 4 June (www.cmaj.ca/pdfs/171_1_news.pdf). "CMAJ抯 investigation has elicited reports of the deaths of at least 79 patients in several institutions, all of whom contracted the infection in 2003 or the first few months of 2004," says the journal. "By comparison, in all of Canada 44 people died from SARS during last year抯 outbreak in Ontario."
At least 12 Montreal hospitals have been trying to contain the outbreaks for 18 months. Calgary hospitals, which experienced a major outbreak in 2000-1 that later subsided, have seen a rising incidence of 13-15 new cases per 500 beds per month since last autumn. Dr Tom Louie, medical director of the Calgary health region抯 infection prevention and control, is said to have tracked 1167 patients with C difficile from 2001 to date. Infections resulted in 17 colectomies and 10 deaths.
But the journal report says the precise number of deaths and colectomies that occurred after patients contracted the organism in Montreal "is difficult to ascertain, because most of the hospitals CMAJ contacted would not release their individual statistics." A group of infectious disease specialists is now trying to determine the true extent of the problem and to develop strategies to contain it.
Doctors in Montreal disagree about how many deaths have occurred. Dr Sandra Dial, intensive care physician at the Montreal Chest Institute, claims 51 patients at Montreal抯 Royal Victoria Hospital alone died last year after contracting C difficile, with at least 30 of those deaths being directly attributable to the infection. But Dr Vivan Loo, director of infection prevention and control at the McGill University Health Centre, says that the number of people who have died as a direct result of the organism is probably closer to 15.
Doctors are also divided as to whether patients coming into hospital should be warned about the risks. Dr Dial believes that the health and hospital authorities should issue a public warning. The lack of such a statement was keeping patients from making the choice of delaying elective surgery or choosing to be admitted to a hospital with a low infection rates, she said.
But Dr Michael Libman, an assistant professor at McGill University and an authority on C difficile, does not think that the public needs a specific warning, although he does think they should be told that taking antibiotics can precipitate infection with C difficile and that they should be educated about the importance of handwashing.
"In any given day or month, things are going on in the hospital that affects the patient抯 risk. I don抰 know why we should be picking C difficile out of the multitude of risks to put emphasis on," he says. "It would be more frightening than anything else to take . . . low-risk elective patients and frighten them with numbers that probably have very little impact statistically on their cases."
C difficile is a common cause of infectious diarrhoea in industrialised countries and has been increasing in prevalence and severity. It occurs in some patients after they have taken prescribed antibiotics, and, once established in the intestine, it produces a toxin that damages the colon, which can be accompanied by haemorrhage. A total colectomy may be necessary. The organism forms spores that can survive for long periods outside the body and are resistant to common hospital disinfectants. It is spread by hand-to-hand contact.
Dr Todd McConnell, physician in chief at St Mary抯 Hospital, Montreal, calls C difficile "almost a pandemic" and "a huge concern to the medical community."(Quebec David Spurgeon)