Death toll reaches 21 in Ont. C. difficile outbreaks

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Death toll reaches 21 in Ont. C. difficile outbreaks

CTV.ca News Staff

Date: Monday Jul. 11, 2011 5:31 PM ET

Another death in an Ontario hospital has been linked to C. difficile just as

health officials say they are making progress in the battle against a number of

the highly contagious outbreaks.

So far, three hospitals have been cleared of outbreaks of the deadly superbug,

while seven health centres are still trying to contain them.

Health officials said on Monday that the elderly patient who tested positive for

the infection died over the weekend at Guelph General Hospital. Two more cases

have also been reported at the hospital since Friday.

Hospitals in Guelph, St. Catharines, Niagara Falls, Welland, Orangeville and

Mississauga continue to fight cases. Three hospitals, in Toronto, Hamilton and

Napanee, have called off outbreaks.

Ontario's acting chief medical officer, Dr. , says it could take

weeks before outbreaks at the remaining hospitals are considered over. Hospitals

must wait 30 days after every case acquired in hospital has cleared before

calling off an outbreak.

Eliminating the bacteria can be difficult since the bug produces spores that can

contaminate surfaces and that resist most cleaning products. That's in part why

C. diff is one of the most common causes of infectious diarrhea in hospitals and

long-term care homes.

Health Minister Deb s says experts are working to determine whether all

the outbreaks are related.

Of the 100 or so people sickened in the outbreaks, most are being treated with

antibiotics. But for patients with stubborn cases or who suffer relapses,

doctors sometimes turn to a last-ditch treatment called a fecal transplant.

The very idea might make some squeamish, but the treatment can work, says Dr.

Lee, the medical director for infection prevention and control at St.

ph's Healthcare in Hamilton, Ont. A fecal transplant is exactly what it

sounds like: doctors take stool material from a healthy patient and transplant

it through an enema into the large intestine or colon of a patient with a C.

difficile infection.

" The idea behind transplantation is to restore healthy bacteria so that they can

combat the disease-producing Clostridium difficile, " Dr. Lee explained to CTV's

Canada AM Monday.

Unlike other medical transplant procedures, there is no need to find a " match "

either for genes or blood type. Anyone can be a donor; they simply need to be

screened for infectious diseases such as HIV and hepatitis.

Potential donors also need to be carefully screened to make sure they don't have

a mild C. diff infection that is not showing symptoms. The donor is typically a

family member or a spouse.

While C. difficile is widespread, with up to five per cent of the population

currently carrying it at any time, the bacteria can overpopulate the intestinal

tracts of vulnerable patients, usually those already suffering from other

ailments and those taking antibiotics.

The bacteria cause difficult-to-control diarrhea, which can lead to blood

infections and sometimes death. In the outbreak in Ontario that began in late

May, more than 100 people have been confirmed with infections and 21 have died,

most of them elderly.

The idea of fecal transplants isn't new: doctors have reported success with it

for decades. But the treatment hasn't been well-studied, so many doctors have

been reticent to try it.

Instead, they stick with the usual treatment, which is high doses of

antibiotics. That method might seem ironic, since it is often antibiotics that

caused the overgrowth of C. difficile in the first place. Nevertheless,

antibiotic treatments are effective in about 60 to 80 per cent of patients, says

Lee.

For those who don't respond, or who have lingering symptoms or recurring

infections, fecal transplants can offer a cure, says Lee.

" The overall efficacy based on our experience has been over 90 per cent

success, " she says.

Gill Dawson and Elaine , whose parents, and Margaret Dawson, both

died from infections with the superbug within 10 weeks of each other in this

latest outbreak, told CTV's Canada AM last week that they don't understand why

doctors didn't try fecal transplants to try to save their parents' lives.

But for the most part, the procedure isn't widely available in Canada. Lee

explains that a number of infrastructure aspects have to be in place at a

hospital that's treating an infected patient.

" First of all, a microbiology lab has to be on site and secondly, you have to

have willing and pre-screened donors who are available, " she explained. " And

third is support from the hospital administration. At St. Joe's, we're fortunate

to have all three of those. "

With files from The Canadian Press