Clostridium difficile Infections

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Have you heard?
Some retail meats contain C. difficile

  • C. difficile, a bacterium which causes diarrhea and is primarily associated with healthcare settings, has recently been identified in some retail meats
  • C. difficile organisms, including recently identified human epidemic strains, have been identified in retail meats, including beef, pork, turkey and ready-to-eat meats.
  • It is not known how these bacteria got into the meat.

The role that food, including retail meat, plays in human C. difficile infection (CDI) is not known

  • It is not known how much C. difficile in food one would have to ingest to become sick.
  • There are NO documented cases of people getting CDI from eating food that contains C. difficile.
  • Therefore, at this time, CDI is not thought to be a foodborne illness.

Most of the human burden of CDI is healthcare associated

  • If animal-to-human transmission through meat does occur, it is likely to account for only a small proportion of the overall burden of human CDI.

CDI is mostly healthcare-associated (approximately 80%)

  • The majority of human cases of CDI occur in association with inpatient stays in hospitals and long-term care facilities.
  • The majority of cases occur among the elderly, but other people, including children, with other illnesses or conditions that weaken the immune system are at greater risk of acquiring this disease.
  • Antibiotic use to treat other infections is a major risk factor for CDI. These drugs decrease the body’s natural protection against CDI.
  • The main way C. difficile is spread is among patients in healthcare facilities through contact with bacteria found in feces of infected patients. People can become infected if they touch items or surfaces that are contaminated with feces and then touch their mouth or mucous membranes. Healthcare workers can spread the bacteria to other patients or contaminate surfaces through hand contact.
  • The most important control point for preventing CDI in humans is the healthcare setting.

Some CDI is community-associated (approximately 20%)

  • Recent reports suggest that CDI in persons with little or no exposure to healthcare facilities (i.e., “community associated”) may be increasing. The source of C. difficile in these patients is not known but may include other persons (i.e. C. difficile may be found in 3-5% of healthy persons living in the community), food, or visits to outpatient healthcare settings.
  • Early in 2006, CDC reported on the presence of severe CDI in healthy persons living in the community and pregnant or recently pregnant women, both of whom are populations previously thought to be at low risk.
  • Generally, community-associated CDI cases occur in younger, healthier patients who use antibiotics less frequently.
  • Although the use of antibiotics is a major risk factor in healthcare-associated CDI, some of the patients with community-associated CDI were not using antibiotics at the time of their diagnosis, or in the recent past (within 2-3 months).
  • Certain features of CDI that have been uncommon in the past, such as high recurrence rate, young patient age, bloody diarrhea, and lack of antimicrobial exposure, might be changing.

Animals can carry C. difficile

  • Healthy adult food producing animals, such as beef and dairy cattle, may carry C. difficile.
  • C. difficile has recently emerged as an important cause of disease in neonatal pigs.
  • C. difficile may be found in healthy companion animals such as horses, dogs, and cats.
  • There are no documented animal to human cases of CDI. (There has been one incident reported in the literature where a pet therapy dog was thought to have contracted the human epidemic strain of C. difficile while visiting a hospital, although it has not been proven that the origin of the dog’s infection was the hospital.)

CDC is working to lower the risk of contracting C. difficile

  • CDC is working with hospitals to look at which antibiotics are most important in contributing to CDI outbreaks. We are also examining the role of the environment in the spread of these bacteria to determine whether improved environmental cleaning measures could control a C. difficile outbreak. These measures include: judicious use of antibiotics, strict hand hygiene, contact precautions for patients with known or suspected CDI, and implementation of an effective environmental cleaning and disinfection strategy. Facilities experiencing an outbreak should also consider using only soap and water for hand hygiene when caring for patients with CDI; alcohol-based hand rubs are not effective in eradicating C. difficile spores.
  • CDC is working to identify research needs to learn more about CDI in foods. This includes working with various experts in food safety and veterinary medicine.
  • As the United States Department of Agriculture (USDA) is the government agency responsible for regulating the safety of meat, CDC is working closely with them and sharing emerging information as it becomes available regarding CDI in retail meats.

For more information on CDI, including frequently asked questions and answers, please visit CDC’s Division of Healthcare Quality Promotion website at: http://www.cdc.gov/ncidod/dhqp/id_Cdiff.html

To read a blog posting on this subject by Dr. Ali Khan, Deputy Director of the National Center for Zoonotic, Vector-Borne, and Enteric Diseases, go to: http://www.cdc.gov/nczved/blog/

Date last modified: April 22, 2009
Content source: 
Division of Healthcare Quality Promotion (DHQP)
National Center for Preparedness, Detection, and Control of Infectious Diseases