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C. diff Epidemic Will Get Worse

Oct 31, 2008 | Parker Waichman LLP A panel of experts is saying that this country’s epidemic of the potentially dangerous superbug Clostridium difficile, or C. diff, will probably worsen before any improvement is seen.

Cases of the C. diff diarrhea bug have now been seen in all 50 states, says L. Clifford McDonald, MD, of the Center for Disease Control and Prevention’s (CDC) Division of Healthcare Quality and Promotion.  And "we haven't hit bottom yet," says Lance Peterson, MD, of the Evanston Northwestern Healthcare Research Institute in Illinois.

Typically, C. diff occurs in people taking antibiotics.  Spores enter the body through the mouth and travel to the gastrointestinal tract.  It is the overgrowth of the C. diff bacteria in the colon, or large intestine, that can lead to diarrhea, which is often severe and accompanied by colitis, or intestinal inflammation.  M. Lindsay Grayson, MD, vice chairman of the committee that chose which studies to highlight at the meeting and an infectious diseases specialist at Austin Health in Melbourne, Australia points out that antibiotics can kill the "good" bacteria in the colon that keep C. diff from running amok.  Experts met at a joint meeting of the American Society for Microbiology and the Infectious Diseases Society of America.  Grayson also noted that infection rates are often high in hospitals and nursing homes, where patients and health care workers are in close proximity.  Because of this, C. diff cannot be eradicated with standard cleaning agents.

Meanwhile, hospital discharge data reveal a four-fold increase in C. diff rates since 2001, said McDonald, while related deaths have increased fivefold.  According to the CDC, C. diff is the culprit in tens of thousands of diarrhea cases and no less than 5,000 deaths annually.

Both the Infectious Diseases Society of America and the Society of Healthcare Epidemiology of America have published guidelines meant to minimize the spread of the C. diff superbug that include avoiding the overuse of antibiotics, using bleach to clean surfaces during outbreaks, wearing gowns and gloves when caring for patients, and following strict hand washing and other good hygiene practices.

Although the antibiotics vancomycin and metronidazole are generally used to treat C. diff, both drugs are no longer helping many patients, most especially those undergoing repeat bouts of C. diff, says Dale Gerding, MD, of Hines VA Hospital in Chicago.  "We've had the same therapies for 30 years and new ones are desperately needed," he added.  One controversial procedure that has some success, but has not been widely used in the U.S. is a so called "fecal transplant," Gerding says.  This procedure involves doctors obtaining a stool sample from a healthy relative of the patient, typically a spouse.  The doctors then filter the sample and infuse it into the C. difficile patient, usually by nasal tube.  The fresh stool is meant to restore those bacteria that were taken from the infected person's intestines with the antibiotic treatment, Gerding says.  Fecal transplant is “highly effective, with success rates of about 90%.  But hospital safety boards are reluctant to approve its use as they fear other pathogens could also be introduced [into the patient]," he says.


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