HOSPITAL INFECTIONS N EWS C. difficile hits Sherbrooke, Que., hospital: 100 deaths Published at www.cmaj.ca on Aug. 4, 2004. Doctors at a Sherbrooke, Que., C. difficile is also rising. The Cliff McDonald, a medical epi- hospital have lost 100 patients in hospital had 325 cases in the demiologist at the Centers for the last 18 months to Clostrid- first 6 months of 2004, and 390 Disease Control and Prevention. ium difficile, the same infection cases in 2003 — up from 169 “Thirty percent or so of [in- that is dogging wards in Mon- cases in 1991–92. fectious disease] doctors have tréal and Calgary hospitals, “If it continues at current perceived an increase,” McDon- CMAJ has learned. rates, incidence rates for 2004 ald told CMAJ. “It seems like In the first 6 months of this will be roughly double that of the disease is more severe. My year, 46 patients at the Centre 2003,” says Pépin, who estimates gut feeling is that we are having Hospitalier Universitaire de between 20%–25% of cases an increase [in incidence and in Sherbrooke died within 30 days were acquired in the broader deaths], that something new is of being diagnosed with C. diffi- community. going on.” cile-associated diarrhea (CDAD), The infection is not under The CDC hopes to make the and 54 patients died in 2003, control in Sherbrooke or Mon- link to a new strain of C. difficile says Dr. Jacques Pépin, an infec- tréal, says Pépin, calling for ur- by testing samples from differ- tious disease consultant at the gent action from the Quebec ent geographic locations. It’s hospital and a professor at Sher- Ministry of Health to recognize critical for hospitals to share brooke University. the outbreak as “a public health data to determine the scope of He believes this is an under- emergency.” The ministry has the problem, says McDonald. estimate of the actual incidence, formed a committee to investi- C. difficile is not a reportable calling it “the worst epidemic of gate. Health Minister Philippe disease in any province or in the hospital-acquired infections that Couillard was not reachable by US, although Manitoba plans to we’ve had.” deadline. add it by 2005. “Given that the situation is as An administrator at the Sher- Pépin and his colleagues at the bad throughout Montréal and brooke hospital described the University of Sherbrooke’s De- the Montérégie region, it seems situation as a “crisis.” Public partment of Microbiology and In- likely that before the end of health officials and the Quebec fectious Diseases are calling on 2004, more than 1000 patients ministry should respond faster, the federal government to accel- will have died within 30 days of says Jacques Poisson, the associ- erate research into the extent, a diagnosis of CDAD in the ate director of professional ser- causes and treatment of C. difficile. province of Québec,” he says. vices. “The measures that were Health Canada should also In June, CMAJ reported on at adopted [to combat SARS] were coordinate a response to the least 83 deaths in Montréal and very aggressive compared to outbreak, through its new Pub- Calgary (CMAJ 2004;171[1]:19- what we’re doing right now.” lic Health Agency and by in- 21), based on the 2003 and 2004 Pépin says part of the reason volving the national disease con- data from some of the affected health officials may be reacting trol laboratory in Winnipeg, hospitals. Not all affected hospi- less vigorously to the outbreak Pépin suggested. tals would release data. is because most of those dying He believes the only long- Pépin, whose research was are elderly. “There’s less reac- term solution is to renovate hos- early released by CMAJ (see tion than if it had been an out- pitals so patients have private DOI:10.1503/cmaj.1041250 page 466), finds the incidence of break among younger patients.” rooms with toilets, or at least im- In 2003, the incidence of the proved access to toilets, thereby disease in Sherbrooke increased limiting the spread of infection. to 156.3 per 100 000, up from Investing in hospital up- 33.2 in 1991. Among individuals grades would ultimately save aged 65 and older, the incidence money, since it costs $10 000 to has increased 10-fold, from 85 $12 000 per patient to treat C. per 100 000 in 1991–92, to difficile, Pépin says. By that esti- 866.5 in 2003. mate, it cost more than $7 mil- The proportion of people lion in Sherbrooke to treat 715 who died within 30 days of diag- patients in the last 18 months. nosis in Sherbrooke increased to “It won’t be an easy solu- 13.8% in 2003, up from 4.7% in tion, like giving talks to the US Centers for Disease Control and Prevention 1991–92. Pépin believes C. diffi- nurses and students and resi- C. difficile, an anaerobic gram-positive rod, is cile may be evolving into a more dents in terms of hand-wash- the most frequently identified cause of antibi- virulent, toxic strain of the disease ing,” says Pépin. “It will take otic-associated diarrhea, accounting for ap- than physicians previously saw — political commitment.” — proximately 15%–25% of all episodes. an opinion he shares with Dr. Laura Eggertson, CMAJ 436 JAMC • 31 AOÛT 2004; 171 (5).