Clostridium difficile: The Evolving Story

In September 2007, the Public Health Agency of Canada (PHAC) announced its intention to develop a plan by January 2008 to reduce the number of infections occurring in the nation's hospitals (1). This comes at a time when the Safer Healthcare Now! campaign is exploring how it can build on efforts already underway in hospitals to decrease the transmission of antimicrobial-resistant organisms (S Paton, PHAC, personal communication). While methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci are the pathogens that usually come to mind when considering antimicrobial-resistant organisms, Clostridium difficile is also foremost in the minds of health care workers and patients when health care-acquired pathogens are mentioned. The concern over C difficile is supported by recurring stories in the public press of outbreaks of C difficile attributed to poor hygiene in hospitals (2,3), and scientific literature that suggests the emergence of a more contagious and virulent form of this pathogen in both hospital and community settings (4–6). It is instructive to consider how C difficile has evolved over the past 30 years, even since our last review of this topic in 2000 (7).