Clostridium difficile: GI infection

[Guest guest]

 

 

http://www.nytimes.com/2009/04/14/health/14well.html

[C. difficile is one of the infections covered in the GI-2

test from Diagnos-Techs. I find it particularly common

after someone is treated with the drug Cipro, against

which I always advise. - Pat.]

New York Times

Tuesday

April 14, 2009

-- Stomach Bug Crystallizes an Antibiotic Threat --

By Tare -Pope

Earlier this year, Harold and Freda of Como, Miss., both came down with

a serious stomach bug. At first, doctors did not know what was wrong, but the

gastrointestinal symptoms became so severe that Mrs. , 66, was

hospitalized for two weeks. Her husband, a manufacturing supervisor, missed 20

days of work.

A local doctor who had worked in a Veterans Affairs hospital recognized the

signs of Clostridium difficile, a contagious and potentially deadly bacterium.

Although the illness is difficult to track, health officials estimate that in

the United States the bacteria cause 350,000 infections each year in hospitals

alone, with tens of thousands more occurring in nursing homes. While the

majority of cases are found in health care settings, 20 percent or more may

occur in the community. The illness kills an estimated 15,000 to 20,000 people

annually.

" It's been the worst thing I've ever tried to get through in my life, " said Mrs.

, who remains weakened by the ordeal. " I really did think I was going to

die. "

What is so frightening about C. difficile is that it is often spurred by

antibiotics. The drugs wipe out the targeted illness, like a urinary tract or

upper respiratory infection, but they also kill off large portions of the

healthy bacteria that normally live in the digestive tract. If a person comes

into contact with C. difficile, or already has it, the disruption to the

beneficial bacteria creates an opportunity for the harmful bacteria to flourish.

The public health community has been sounding the alarm for years about the

overuse of antibiotics and the emergence of " superbugs " — bacteria that have

developed immunity to a wide number of antibiotics. But the C. difficile problem

shows that the threat is not generalized or hypothetical, but immediate and

personal.

" One of the things that we counsel consumers about is to make sure that an

antibiotic is really necessary, " said Dr. Dale N. Gerding, an infectious disease

specialist at the Stritch School of Medicine at Loyola University in Chicago.

" There are many good reasons for taking an antibiotic, but an illness like

sinusitis or bronchitis winds up being treated with antibiotics even though it

will go away by itself anyway. "

Even appropriate use of antibiotics can put a person at risk. Dr. Gerding said

his own adult son came down with a C. difficile infection after taking

antibiotics for tonsillitis.

The typical treatment for C. difficile is another course of antibiotics,

typically the drug vancomycin. But the situation can quickly turn tragic. The

Centers for Disease Control and Prevention has reported on several cases of

pregnant and postpartum women who developed life-threatening C. difficile

infections after being treated for minor infections. In some instances, a C.

difficile infection can be treated only by emergency surgery to remove the

patient's colon. Doctors say many patients report that they continue to suffer

from regular bouts of diarrhea even after the infection is gone. About 20

percent of patients with the infection suffer a relapse, and C. difficile

support groups have emerged on the Internet.

In the case of the family, Mr. had been taking antibiotics for

another health problem, and the treatment apparently led to his C. difficile

infection. Mrs. probably contracted the illness from her husband. The

spores from C. difficile are hardy, and contaminated surfaces must be scrubbed

down with bleach to eradicate the germ. Doctors say Mrs. 's illness is

unusual because most people are protected by their own bacterial flora and

wouldn't be vulnerable to C. difficile if they had not been taking antibiotics,

even after close exposure. The risk of contracting C. difficile outside the

health care setting remains low, at about 7 cases per 100,000 people, studies

show.

C. difficile is not a new illness, but it appears to be spreading at an alarming

rate. The rate of C. difficile infection among hospital patients doubled from

2001 to 2005, according to an April 2008 report from the C.D.C. The rise in C.

difficile cases around the world is linked with the growing use of all

antibiotics, particularly a class of drugs called fluoroquinolones, which came

into widespread use around 2001. The use of acid-suppressing drugs, including

proton pump inhibitors like Prilosec, also may be a risk factor, although

studies have been contradictory.

In addition to becoming more common, C. difficile is also becoming more deadly.

Several years ago, the mortality rate from a C. difficile infection was around 1

to 2 percent. But today, various studies estimate that the death rate is 6

percent. The reason is that a hypervirulent strain has emerged that emits higher

levels of toxins than earlier strains.

Many patients are far more familiar with another superbug, methicillin-

resistant Staphylococcus aureus, or MRSA, which can cause a severe and

potentially deadly skin infection. MRSA started off primarily as a

hospital-based infection but has become increasingly common in the community.

Hospitals may become more motivated to control C. difficile if the Centers for

Medicare and Medicaid Services decides to withhold reimbursement for cases of

hospital-acquired C. difficile infections. The system already withholds

reimbursement for certain other preventable hospital infections.

In addition to careful use of antibiotics, patients and hospital visitors should

always be vigilant about hand washing, and visitors should not sit on a

patient's hospital bed or use a patient's restroom if it can be avoided.

Patients should always report severe diarrhea symptoms to a doctor, particularly

if they have taken antibiotics recently.

" Up until about 2002, this was a very mild disorder and very few people ever

died from it, " said Dr. Hookman, a gastroenterologist and associate

professor of medicine at the School of Medicine at the University of

Miami. " But in the past few years the bugs have become hypervirulent, more

severe and now it's a global threat. "

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_____

Love, Gabby. :0)

http://stemcellforautism.blogspot.com/

 

" I know of nobody who is purely Autistic or purely neurotypical. Even God had

some Autistic moments, which is why the planets all spin. " ~ Jerry Newport