AKRON, Ohio – John Sauter and Jim Tall are either unrelated medical anomalies or harbingers of a scary bacterial outbreak to come.

In the past nine months, both men have come down with lingering infections from Clostridium difficile, or “C. diff,” an odd bacterium that not only survives but also thrives on standard antibiotic use.

Typically, C. diff infections are found in elderly patients who are taking antibiotics during hospital or nursing home stays.

But neither Sauter, 49, nor Tall, 53, fits that profile.

Sauter, a former Akron resident who now lives in New Jersey, had been on an antibiotic to treat a sinus infection, but he hadn’t set foot in a hospital or nursing home shortly before getting C. diff.

Tall, who lives in Canton, Ohio, had been visiting his aunt in a nursing home, but he had not been taking antibiotics.

Although such cases have been considered rare, federal health investigators are beginning to wonder whether a newer, nastier strain of C. diff – like the one causing an increasing number of deaths in Canada – is striking younger targets who may not have been exposed to antibiotics, hospitals or nursing homes.

“We are curious if the profile of patients who get C. difficile may be changing,” said Dr. L. Clifford McDonald, a C. diff expert at the U.S. Centers for Disease Control and Prevention. “We were wondering whether this new strain might be part of this. We don’t know yet.

“This is something we’re actively looking into.”

C. diff has long been one of the most common hospital-acquired infections and a leading cause of antibiotic-associated diarrhea. But now a highly toxic strain of the bacterium is spreading through U.S. hospitals in nine states, including Maine.

This strain, which killed more than 100 patients in Quebec hospitals in six months, causes severe diarrhea and colon damage.

Tracking the disease is difficult in the United States. C. diff is not classified as a reportable disease, meaning public health officials are not notified of cases and do not gather statistics on the disease, even in those cases ending in death.

In April, the Society for Healthcare Epidemiology of America offered perspective on the problem when it released a survey of 201 infectious disease experts. Nearly two in five (38 percent) reported seeing an increase in the number and severity of C. diff cases.

Of the 3,292 patients referred to in the survey, 181 (5.5 percent) required removal of the colon, and 198 (6 percent) died.

The new strain, which carries 20 times the amount of toxin of previous C. diff strains, has been found in Ohio, Pennsylvania, Connecticut, Florida, Georgia, Illinois, Maine, New Jersey and Oregon.

Dr. Stephen Sears, an infectious diseases specialist and the chief medical officer at MaineGeneral Health in Augusta, said the new strain of C. diff has been on the radar in Maine for close to two years.

Because doctors are not required to report the infection to the state, he said, and because many cases doubtless go undiagnosed, there’s no accurate way to know how many Mainers have been sickened. He estimated the number is “in the hundreds,” adding that C. diff has probably been a factor in the deaths of many Mainers already weakened by other disorders.

Sears said the new strain has been identified at hospitals and nursing homes across the state and is not limited to any one region.

Doctors in Akron noticed the change in C. diff late last year.

“Patients are often sicker than they used to be,” said Dr. Gary Bollin, chief of infectious disease at Akron General Medical Center. “Rather than just diarrhea, we’re seeing high fevers and high white blood cell counts. They tend not to respond as quickly to antibiotics as they did in the past. They often require second- and third-line treatment and require more surgical intervention, something that was unusual in the past.”

CDC’s McDonald said, in the past, cases such as Sauter’s have occurred at a rate of less than one in 10,000 antibiotic prescriptions.

“So, historically, at least, this was an unusual event,” McDonald said. “We’re hearing these stories, too [at the CDC]). The numbers seem unusual.”

McDonald said there’s some debate in the medical community about whether cases like Sauter’s stem from C. diff spores that are lying dormant in the patient’s intestines or from contact with C. diff elsewhere in the community.

In most people, C. diff is kept in check by the other bacteria normally living in the colon. But when a person takes an antibiotic for another ailment, the protective bacteria in the colon are killed off, allowing C. diff to flourish.

Toxins from C. diff attack the lining of the colon. In most cases, treatment is with two specific antibiotics: metronidazole (Flagyl) or vancomycin (Vancocin). If treatment fails, the toxins can cause tissue to die, requiring surgery to remove the colon.

The rise in C. diff infections is causing hospitals to make sure that staff members comply with infection control policies.

When dealing with C. diff patients, that means limiting antibiotic use, wearing gloves and gowns, using stethoscopes dedicated to only one patient, emphasizing room-disinfection techniques and most importantly, practicing proper hand-washing with soap and water, not alcohol-based hand cleaners.

In Maine, according to Dr. Sears, some facilities are also using a powerful bleach solution to wipe down patient rooms as well as stressing to staff, patients and visitors the importance of observing all infection control measures where C. diff is known or suspected.

The infection is not considered a public health threat here, he said, because it has not been identified outside of health care facilities.

BDN reporter Meg Haskell contributed to this report.