Managing Community-Onset C. Difficile
Sources of transmission and challenges that impact the management of community-onset C. difficile.
Peter L. Salgo, MD: Let’s talk about community Clostridioides difficile for a moment. What are the risk factors in the community, and how do they differ in the community- vs the hospital-based populations? Dale, do you want to start us on that?
Dale N. Gerding, MD: That’s a really good question because there’s 2 factors that we need to have in order to get C diff. One is antibiotic use, and the other is exposure to the spores. So the spores are ubiquitous. They are in the environment, and they even contaminate at a very low level some foods, meats, root vegetables, and lettuce. Those are probably how patients in the community get exposed. On the other hand, when the CDC [Centers for Disease Control and Prevention] has looked at community-associated C diff they found that about 80% of these patients have had an exposure to health care as an outpatient. So it’s doctor’s office, dental office, and chronic dialysis units, ambulatory surgery. This is where you have 2 risks. One is that somebody is going to give you an antibiotic. Those are called “doctors.” [Laughter.] They put people at risk of C diff. The other exposure is that the health care environment is more contaminated with C diff spores than is the environment outside health care.
Peter L. Salgo, MD: It’s not just the people who are in the health care system. It’s not just the people who got the antibiotics. They go home, they’ve got spores, and then their families are exposed. It seems to me that that’s part of the issue, isn’t it?
Joseph Reilly, BS, PharmD, BCGP: Those spores can live for a significant period of time on many surfaces, even when exposed to sunlight. You’ll see some data that say, “Alcohol and certain products can kill the spores,” but they really have to be used properly, where the liquid sits on a surface for a significant period of time to have effects. The fact that the spores can be taken home with you on your lab coat and in your house and on surfaces for 6 months, a year, or longer certainly put people at risk.
Peter L. Salgo, MD: If you enjoyed this content, you should subscribe. We have an e-newsletter, and you can receive upcoming Peer Exchanges and other great content in your in-box—that’s right, electronically. I’ll see you next time. I’m Dr Peter Salgo. Thanks again for watching.