Wednesday, May 16, 2018

Jersey! Where Community Acquired C. difficile is Extremely Rare


Where the community acquired C. difficile is extremely rare. I am referring to the Channel; Island of Jersey, with only one microbiology lab and a population of <100,000 people, where the majority of C. difficile cases had recent healthcare contact as referenced in this article in Infection Control and Hospital Epidemiology.

This is in contrast to the much cited NEJM article on diverse C. difficile reservoirs. 

In my opinion, the biggest driver of C. difficile is antibiotic (over)use. Antibiotic presciption can have a population based impact on C. difficile rates, as reported here in The Lancet.

Broad formulary restrictions are likely more effective in countries with a National Health Service.  In the USA, absent a well coordinated health system and given the primacy of physician 'autonomy', such an approach would be seen as counter cultural and unacceptable, even if benefits outweigh harms.

Shame on us.

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