Clostridium difficile: Responding to a New Threat From an Old Enemy

CDC) recently described a novel strain of C. difficile that possesses both unique putative virulence factors and increased resistance to the fluoroquinolones; either may provide this strain with selective advantages over other strains.14 ' 15 This strain was associated with CDAD outbreaks in seven hospitals in six states (Georgia, Illinois, Maine, New Jersey, Oregon, and Pennsylvania) with onset dates during 2001 to 2004.Since this report, we have identified outbreaks of this strain in four additional states (Connecticut, Florida, Massachusetts, and Ohio).My CDC colleagues, Dr. George Killgore and Ms. Angie Thompson, shared in the initial characterization of this U.S. epidemic strain and they have, together with domestic and international collaborators, determined this to be the same strain as that causing outbreaks in Quebec, Canada, 16,17 and, more recently, England.18 The first step in responding to this new threat is to further our knowledge about CDAD; four articles in this issue of Infection Control and Healthcare Epidemiology have been written specifically to this end.19 " 22 In the first of these, Sohn et al. 19 report on varying CDAD rates and surveillance methods among seven tertiary hospitals (ie, the Prevention Epicenter Hospitals).Next, Palmore et al. 20 report on the risk factors for CDAD among outpatients at a cancer hospital.In the third article, Modena et al.21 describe antimicrobial use and other risk factors for CDAD among hospitalized patients during a recent 1-year period.Finally, Rexach et al. 22 report on a spatial and temporal analysis of CDAD transmission in a pediatric hospital during the late 1990s.Our first response to the growing threat of CDAD in North American hospitals is to improve surveillance.Sohn et al. detail the challenges to establishing a highly reliable