New study finds link between doctor’s office and deadly bacteria

Excerpted from “CDC investigates deadly bacteria’s link to doctors’ offices,” CNN. February 26, 2015 — The Centers for Disease Control is raising a red flag that a potentially deadly bacteria may be lurking in your doctor's office. The bacteria, C. difficile, is typically found in hospitals, but a study out Wednesday, February 25 reports a substantial number of people contracted the bug who hadn't been in a hospital, but had recently visited the doctor or dentist.

The bacteria can cause deadly diarrhea, according to the CDC, with infections on the rise. The new report shows nearly half a million Americans infected in various locations in one year, with 15,000 deaths directly attributed to C. diff. The CDC is so concerned that they're starting a new study to try to assess nationally whether people are getting C. diff in doctors' offices.

In the meantime, patients should wash their hands after visiting the doctor's office -- with soap and water, because alcohol-based gels don't get rid of C. diff. Another tip: Question your doctor whenever you're prescribed an antibiotic. Powerful broad-spectrum antibiotics wipe away good bacteria in your gut that fight off the bad bacteria, which leads the way to C. diff. Johns Hopkins safety expert Dr. Peter Pronovost recommends asking your doctor if you really need an antibiotic, if there's a less powerful one that will treat your infection, and if you're being prescribed the antibiotic for the shortest time possible.

The CDC study, published Wednesday in The New England Journal of Medicine, said 150,000 people who had not been in the hospital came down with C. diff in 2011. Of those, 82% had visited a doctor's or dentist's office in the 12 weeks before their diagnosis. The CDC is hoping its new study will help determine cause and effect, because it's possible the patients had C. diff to begin with and went to the doctor to get help. It's also possible that antibiotics prescribed during the doctor's visit, and not microbes at the doctor's office, caused the infection.

Commentary

Infectious Disease Specialist and CMDA Member Eva Quiroz, MD: “Clostridium difficile infections are of significant concern given the recent CDC reports of increased incidence, mortality and changing epidemiology of the disease. CDC reported half a million infections in the year 2011, and 29,000 people died within 30 days of initial diagnosis.

“Two of the most common preventable risk factors are: antibiotic prescription and infection control practices. (There are also many other risk factors being investigated such as food, animals and household contacts.) Antibiotics disrupt intestinal microbiota which renders a person more susceptible to illness. One study showed that some bacteria remain disrupted for long periods of time: up to two years following treatment with Clindamycin and up to four years after treatment for H. Pylori with Clarithromycin, Metronidazole and Omeprazole.

“I recommend screening our patients for diarrhea much like we screen for the flu. I would ask about history of diarrhea more than three times per day, any antibiotic exposure and exposure to anyone in the household who is ill with diarrhea. You can then test for c. diff if pertinent. We can also educate our patients about the perils of taking antibiotics when not needed, the importance of hand hygiene and how to avoiding handling food while sick with diarrhea.

“The organism is a spore and it might survive longer in the environment, so you need to decontaminate exposed areas with a sporicidal agent and wash your hands with soap and water between patients, even if you use gloves. The danger of acquiring the infection not only lurks in our offices but anywhere we are exposed to the spores excreted in the feces of an infected person.”

Resources

More information from CDC