Concerns about rising incidence of C. difficile in younger patients in other countries are prompting warnings from the United States Centers for Disease Control and Prevention and mandatory reporting changes in the United Kingdom.

C. difficile is a potentially life-threatening infection primarily affecting elderly and severely ill patients, but experts say it is becoming more frequent in patients younger than 65.

Dr. Cliff McDonald, a C. diff expert at the Centers for Disease Control in Atlanta, Ga., says hospitalization data in the U.S. points to increased cases in those aged 15 to 65 although the biggest increase remains in the highest-risk patients -- those over 65.

There were 301,200 hospital C. difficile cases in 2005 in the United States, more than double the number in 2000.

Two-thirds of the patients were 65 years or older.

Although the increases in younger patients are not as dramatic, authorities should still be concerned C. difficile is showing up in the young and even pregnant women, patients previously considered low risk, he said.

McDonald said the CDC sounded the alarm in December 2005 on the rising incidents in younger patients.

In Wales, the government has just announced it is extending its mandatory C. difficile reporting to include cases of patients from ages two to 65.

Currently, the reporting involves those over 65.

The move was prompted by concerns about increased C. difficile rates in younger patients in England.

The superbug hit 738 patients between ages two and 65 last year. There were 2,799 cases in those over 65.

Ontario is introducing mandatory reporting Sept. 30 on the number of patients infected with C. diff, but hospital personnel have to be trained on how the system will work.

A Spectator tally of 22 Ontario hospitals shows 463 patients infected with C. difficile died from January 2006 to May 2008.

This includes Burlington's Joseph Brant Memorial Hospital, where 91 infected patients died. C. diff was found to have caused or contributed to 62 of those deaths.

Dr. Michael Libman, director of the infectious disease division at McGill University Health Centre, sees value in recording younger cases because "generally the more information, the better."

Mandatory reporting is in effect in Quebec, where C. difficile was blamed for about 2,000 deaths following an outbreak there in 2003, but it does not break it down into age groups, Libman said.

cfragomeni@thespec.com

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