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Controlling C. difficile in the community could cut infection rates in hospitals

6 April 2007

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Screening people for Clostridium difficile before they are admitted to hospital may be one way to help control rising rates of infection, says a doctor in today’s British Medical Journal (Hospital acquired infection. BMJ 334;708).

Recent data published by the Health Protection Agency (HPA) show that each year in England around 7,000 inpatients have MRSA infections, and more than 50,000 inpatients aged 65 years and over have C. difficile infections. Cases of C. difficile rose by 5.5% in 2006, whereas MRSA cases fell by 4.3% over a similar period. And numbers are likely to continue rising because the population is ageing and the elderly are the most at risk, warns Dr John Starr.

One factor that may be driving infection rates is the community reservoir, he says. He suggests one way to control C difficile would be to screen people before they are admitted electively to hospital to see if they carry the bacterium. Approximately 5% of the population carry C. difficile without any ill effects.

Dr Starr says the percentage of carriers could be substantially higher in people connected with hospitals, and this in turn could lead to infections being acquired in the community. This could be one reason, he argues, for the growing rate of infection. He points out that the relative increase in community acquired C. difficile is far outstripping that seen in hospitals.

Thirteen thousand people become infected in the community every year, of those three quarters have not been to hospital in the previous 12 months, he adds. This raises the question of whether C. difficile can still be thought of as purely a hospital-acquired infection and, if not, whether other infection control measures are needed.

It is important to consider whether a C. difficile infection control policy solely focused on hospitals remains appropriate, Dr Starr concludes.

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