Outbreak of Diarrhea in Calgary and Montreal

Dear Dr. B: I am concerned about the recent reports of outbreak of diarrhea in Calgary and Montreal hospitals. Can you please explain the cause and effect of this kind of colitis?

“More people have died after contracting a virulent infection that has broken out in hospitals in Montreal and Calgary than were killed by SARS – yet neither public health nor hospital officials warned the public until CMAJ broke the news,” says an article in the recent issue of the Canadian Medical Association Journal (CMAJ).

The bacterium responsible for the outbreak of diarrhea is called Clostridium difficile (C. difficile). The condition is known as Clostridium difficile-associated diarrhea (CDAD).

In the last 18 months, at least 12 hospitals in Montreal have been fighting CDAD. More than 1400 patients have tested positive to this organism in that city. At least 79 people have died in Montreal and four in Calgary from C. difficile infection.

The organism was first described in 1935. In the last 25 years, it has been recognized that C. difficile can cause mild to life threatening diarrhea – also called psuedomembranous colitis.

The C. difficile infection is most commonly associated with antibiotic use. The antibiotics cause disruption of normal bacterial flora in the gut and allow C. difficile to thrive and produce toxins which causes diarrhea. C. difficile is resistant to most common antibiotics. Hence, the difficulty of controlling the infection.

July 16th issue of the CMAJ has several articles on the subject. One of the articles written by Dr. Thomas Louie from Foothills Medical Centre, Calgary says, “The root cause of outbreaks of C. difficile diarrhea in our hospitals relates to the difficulty of practicing and maintaining good infection control measures in hospitals.” This is because of high occupancy rate in hospitals, intensive antibiotic use and increasingly complex care of patients.

Many hospitals are old, there are few single or isolation rooms, many patients have to share toilet facilities and there is rapid turn over of patients. All these factors make it difficult to control or contain infection.

What’s the situation in Medicine Hat? I spoke with Dr. Wai Chow, Regional Medical Director of Laboratory Services in the Palliser Health Region. He said that there is no evidence of any outbreak of CDAD in our region. The laboratory continues to get sporadic cases of CDAD which is not unusual. Most cases are due to antibiotic use.

Hospitals in Canada are acutely aware of the situation and continue to implement infection control measures. But there is no guarantee that there won’t be another outbreak of CDAD. Changing behavior of bacteria and viruses will continue to challenge our survival, our resources and our skills. SARS and avian flu are good examples.

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