Tuesday, September 18, 2012

Clostridium difficile or C. diff

There has been much recent concern about the rise in pseudomembranous colitis due to Clostridium difficile, or C. diff. See for example, the recent article from USA today.

Some of our patients have asked about our efforts to avoid this serious problem.  Here is an outline of our approach:

(1) In that individuals who are weakened by poor health are at greater risk, we strive to optimize the health of our patients before proceeding with elective surgery.

(2) In that C. diff is transmitted by spores from one individual to another, our medical center strives to isolate any patient with C. diff from others. Routine hand hygiene between patients is practiced.

(3) In that the risk of C. diff is increased for patients on antibiotics, we minimize the duration of prophylactic antibiotics to one day for our elective surgeries.

(4) For individuals who require longer term antibiotics, we advise them to

   (a) Be on the lookout for diarrhea, fever, bloating or abdominal pain and to seek evaluation immediately should these symptoms arise. Most diarrhea that happens during antibiotics is NOT due to C.difficile, but prompt treatment can be essential, so don't be shy about discussing these symptoms with your physician!

   (b) Take enteric coated probiotics including 'friendly' organisms to repopulate the intestine - these include lactobacillus acidophilis, other strains of lactobacillus, bifidobacterium, and saccharomyces boulardii. The enteric coating enables to the organisms to get past the acid of the stomach and on to the intestines. Scientific data supporting this practice are not definitive, but this approach is rational, very safe, and may be quite helpful. Sources for these supplements may be found by online search. Eating yogurt with "live active cultures" may also be highly beneficial.

This program has proven effective in preventing this serious problem, but we remain aware and are interested in all local and national efforts to minimize the risk it poses.

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