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GPs face huge workload rise under new C. difficile guidelines

By Adam Legge

GPs face a huge rise in the number of stool samples they will need to send for lab investigation under new C. difficile guidelines being drawn up by the Health Protection Agency.

The recommendations on community-acquired C. difficile advise that all cases of diarrhoea in the community in people over 65 should be investigated, as should any cases in the under-65s where infection ‘is possible'.

The consultation document also states that community staff with diarrhoea should be investigated for C.difficile and not come into work ‘until the diarrhoea has been shown to be non-infectious'.

But Professor Chris Butler, head of primary care medicine at Cardiff University and a researcher on antibiotic prescribing, said the proposals risked swamping labs with samples and massively increasing workload in practices.

Professor Butler, who also works as a GP in Cardiff, said: ‘To take such a blanket approach to investigating everybody is ridiculous and has serious workload implications. The recommendation in older patients may be justified but there doesn't seem to be any clear definition in which patients C. difficile infection is "possible".'

The new guidelines have been drawn up to replace 1994 recommendations, since when there has been a 50-fold increase to over 50,000 cases in England last year - 20% in younger age groups not previously thought to be at high risk, and approximately 10% acquired in the community.

But Dr David Church a GP in Machynlleth, mid Wales, said his practice would not be following the guidance. ‘We're not going to start testing our staff as soon as they get diarrhoea. We'll do what we do now - tell them not to come into work for 24 hours and see if they get better.'

The lack of general practice representation on the guideline working group - made up of infectious disease specialists, microbiologists, nurses and pharmacists – has also drawn criticism.

RCGP chair Dr Steve Field said: ‘This guidance is divorced from reality and it seems to me that some consultation documents could do with having been consulted on. It would be an absolute catastrophe if everyone over 65 thought they needed to come into surgery with a specimen every time they had a bit of diarrhoea.'

A spokesperson for the HPA said a sub-group of the working party had included PCT representatives and added: ‘This is a consultation document so we're hoping to get comments from stakeholders to better inform the [final] guidance.'

What the new guidance says about community acquired C. difficile infection What the new guidance says about community acquired C. difficile infection

• All cases of diarrhoea in over 65s should be investigated
• Stool samples should be tested in anyone where CDI ‘is possible'
• Staff with diarrhoea should be investigated and not come into work until results are clear
• Proton pump inhibitors should only be used where there is a clear clinical indication
• Antibiotic prescribing should be in line with HPA recommendations

C.difficile

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