http://www.yourlawyer.com/topics/overview/clostridium_difficile Sat, 21 Nov 2009 23:43:51 -0800 pixel-app en http://www.yourlawyer.com/articles/read/15595 Mon, 01 Dec 2008 00:00:00 -0800 http://www.yourlawyer.com/articles/read/15595 C. diff has been making the news lately and now, a new antibiotic resistant strain of the diarrheal illness is showing up in health care facilities nationwide, reports the East Volusia News-JournalOnline.com.  The federal Centers for Disease Control and Prevention (CDC) also reports C. diff has been seen in all 50 states.  Meanwhile, the Infectious Diseases Society of America and the Society of Healthcare Epidemiology of America have both published guidelines meant to minimize the spread of the C. diff superbug that include avoiding the overuse of antibiotics.  

Clostridium difficile—widely known as C. diff—has been a long-recognized problem in healthcare facilities but, now, officials from the Florida Department of Health are beginning to see a deadlier form of the germ in hospitals there as far back as 2000, reports the East Volusia News.  According to the report, the infection is becoming especially problematic in people over age 60.  A review conducted by the Florida Health Department revealed that nearly a decade ago, C. diff cases were under five in each 1,000 discharges for people between 80 and 90 years of age. By 2006, the figure had “more than quadrupled", the East Volusia News said.  

A recent report issued by the Association for Professionals in Infection Control and Epidemiology are seeing the illness in more patients that first believed.  The report found that C. diff, which was thought to have affected 13 of every 1,000 hospital discharges, is hitting at a rate of 6.5-to-20 times greater, making it the number two super bug, according to East Volusia News.  Methicillin-Resistant Staphylococcus aureus—MRSA—is the top super bug affecting approximately 36 of every 1,000 discharges, the East Volusia News added.

C. diff is generally transmitted by hand contact with items contaminated by feces, causing symptoms ranging from severe diarrhea to deadly sepsis, which seems to worsen in patients who have recently been on or are currently on antibiotics, reported the East Volusia News.  “What happens is the antibiotic you will give them will damage or destroy the friendly bacteria" that can fight off C. diff, said Dr. Richard Duma, director of infectious diseases at Halifax Health, to the East Volusia online paper.

The Canadian Press also just reported that a recent study found that the popular antibiotic Cipro upsets the digestive system’s bacterial balance with such effects lasting longer than first believed.  The paper noted that because antibiotics—which all kill off some amount of beneficial bacteria—cannot isolate one bacteria type, people can develop problems such as yeast infections or, C. diff.  What remains unclear, The Canadian Press notes, is the damage actually done within the body’s bacterial “flora” environment, pointing out that such flora—the good bacteria—are necessary for good health and warding off infections.

]]> http://www.yourlawyer.com/articles/read/15541 Wed, 19 Nov 2008 00:00:00 -0800 http://www.yourlawyer.com/articles/read/15541 Clostridium difficile—C. diff—is present in 40 percent of all grocery meats.

C. diff tends to appear in people on antibiotics and occurs when spores enter the body orally and reach the gastrointestinal tract.  When C. diff bacteria overgrows in the colon, or large intestine, severe diarrhea—often accompanied by colitis, or intestinal inflammation—can set in.  C. diff can be dangerous and is often seen in hospitals and hospital-like settings.  Standard cleansers do not eliminate C. diff and, now, traditional antibiotic treatments no longer seem to be working, especially in repeat cases.

Over “40 percent of packaged meats sampled from three Arizona chain stores tested positive for” C. diff, said the new study of 2006 data collected by a University of Arizona scientist, said MSNBC.com.  Of the samples collected, “nearly 30 percent of the contaminated samples … were identical or closely related to a super-toxic strain of C. diff,” which is pointing to the possibility that C. diff infections “may be transmitted through food,” reports MSNBC.com.  “These data suggest that domestic animals … may be source of C. difficile …” said J. Glenn Songer, a professor of veterinary science at the Tucson school and who spoke with MSNBC.com.  Songer’s work is under review by the federal Centers for Disease Control and Prevention (CDC), noted MSNBC.com.

Songer looked at a wide array of meats sold in grocery stores nationwide and found that contamination ranged from 41 percent (pork), 44 percent (turkey), 50 percent (ground beef), and over 62 percent (braunschweiger, a type of liverwurst), said MSNBC.com.  Of the products contaminated with C. diff, the vast majority—three-quarters—were of toxinotype V, noted the MSNBC.com report, which explained this is a type that has been found in pigs and calves and, “increasingly,” said Songer, in humans.  Last year, a CDC journal piece reported on Canadian researchers who discovered C. diff in 12—20 percent—of 60 retail meat samples collected in 2005 and suggested the possibility that processed meats—because the contain a variety of meats and are handled more—may be likelier to be contaminated, said MSNBC.com.

As with a number of other germs whose contaminations and antibiotic resistance is on the rise, antibiotic overuse is being seen, more and more, to blame, causing situations in which first-line, more traditional treatments are ineffective, noted the piece, which pointed out that 80 percent—and this number is rising—of C. diff infections in hospital or health care settings.  This means, said MSNBC.com, “about 13 in every 1,000 hospital patients is infected or colonized with the bacteria, a rate between 6.5 and 20 times higher than previously estimated,” based on last week’s figures as released by the Association for Professionals in Infection Control and Epidemiology (APIC).  The study also noted that these infections are costing—on average—about $32 million and are resulting in over 300 deaths, said MSNBC.com.

Now, a new, more virulent strain called NAP1, has emerged that produces “about 20 times the toxins of ordinary strains” and can “cause severe, repeated diarrhea that resists all but the most powerful drugs” and can “destroy the colon and lead to blood poisoning and death,” said MSNBC.com.  Also, some C. diff cases are emerging that do not seem to be originating in hospital settings, further confounding experts, the piece indicated.

]]> http://www.yourlawyer.com/articles/read/15484 Tue, 11 Nov 2008 00:00:00 -0800 http://www.yourlawyer.com/articles/read/15484 Clostridium difficile, or C. diff, will probably worsen before any improvement is seen.  Cases of the C. diff diarrhea bug have 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.

Now, a new survey has revealed that over one percent of U.S. hospital patients are infected with Clostridium difficile.  And, although making precise comparisons between prior and new data is challenging, a variety of current studies indicate that the prevalence of C. diff has risen dramatically in the past decade.  "They're all pointing to the same thing: This is a major public-health problem," said McDonald.

Meanwhile, the survey looked at 648 hospitals in 47 states over the course of one day and was was commissioned by the Association for Professionals in Infection Control and Epidemiology, a national professional society whose members include doctors, nurses, and epidemiologists.  The researchers found that 13 of every 1,000 hospitalized patients tested positive for C. diff, with 94 percent also exhibiting C. diff disease symptoms.  The study findings suggest that over 7,000 hospital patients nationwide are infected with C. diff on any given day, and that about 300 will die from C. diff.  The percentage of hospital patients with C. diff disease has more than doubled between 2000 and 2005, according to hospital data analyzed by federal researchers.

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.  Because infection rates are often high in hospitals and nursing homes, where patients and health care workers are in close proximity, C. diff cannot be eradicated with standard cleaning agents.  Worse, the traditional antibiotic treatments no longer seem to be working, especially in cases where people are being treated for repeat bouts of C. diff.

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.  C. diff thrives in patients treated with powerful broad-spectrum antibiotics, which clear away other intestinal bacteria that usually keep C. diff in check.  When possible, doctors are beginning to prescribe narrowly targeted antibiotics.  Also, using a bleach solution to clean the rooms of infected patients is important since C. diff forms hardy spores not killed by some cleaners.  Proper hand washing is also critical, because spores do not always die when alcohol-based disinfectant gels are used.

]]> http://www.yourlawyer.com/articles/read/12391 Sat, 16 Dec 2006 00:00:00 -0800 http://www.yourlawyer.com/articles/read/12391
The Boyle Heights hospital shut its busy neonatal unit Dec. 4 after identifying an outbreak of Pseudomonas aeruginosa, which is believed to have infected five babies.

Then Friday, White Memorial closed its high-level pediatric unit after learning that two older children were infected with the bacterium. Dr. Rosalio Lopez, the hospital's chief medical officer, said he is unsure if the new cases are linked to the outbreak among babies.

Neither unit will be reopened until "we believe it is safe for the patients to be admitted," Lopez said, adding that other parts of the hospital are not affected.

White Memorial officials said they believe that the most likely cause of the outbreak is improper cleaning of a laryngoscope blade, a piece of equipment used to insert breathing tubes. They are working with local, state and federal health investigators to conclusively determine the source.

Lopez said the hospital has tightened its infection control practices, notified the families of patients in the affected units and given antibiotics to all babies remaining in the neonatal unit as a precaution.

"Our first priority is to continue to work with the families affected in this situation," Lopez said. "We're totally committed to providing our patients safe care."

Any critically ill babies born at the hospital now are being taken to a special isolation area to be stabilized before being transferred to other hospitals. High-risk pregnant women are also being advised to consult with their doctors to determine if they should go to White Memorial or another hospital.

About 90% of the hospital's patients are Latino.

'Being extremely cautious'

Los Angeles County public health officials say that their investigation is ongoing and that the number of infected patients may change as test results come in.

"They are being extremely cautious," Dr. Laurene Mascola, chief of the county's acute communicable disease control unit, said of the hospital.

P. aeruginosa is a common bacterium found in water and soil and can be spread through body contact, fluids and water. In most people, it is not deadly or even dangerous, because their immune systems can ward off infection.

But that is not the case in patients with weakened immune systems, such as premature babies, patients with cancer or AIDS and those on breathing machines.

In such situations, the bacterium can cause a variety of infections depending on where it enters the body. These include respiratory, urinary tract and blood infections.

It can spread rapidly and, in some cases, be unstoppable.

Babies in the neonatal unit are especially at risk for infections, because they are often connected to ventilators, tubes, monitors and other equipment that give bacteria an easy pathway to the body.

"It's a group of patients that are very vulnerable," said Dr. Arjun Srinivasan, a medical epidemiologist at the U.S. Centers for Disease Control and Prevention. "They're very sick, so they are at risk of these infections. The care that's delivered for them is very complicated."

The bacterium is particularly deadly for extremely premature and underweight infants, said Dr. Leandro Cordero, director of the newborn intensive care unit at Ohio State University Medical Center. His hospital had an outbreak a decade ago that sickened about 10 infants, most of whom died.

Babies born before 27 weeks of gestation and weighing less than 2 pounds already have a 40% to 50% chance of dying from other causes, Cordero said. But that mortality rate can rise to 70% to 80% with a P. aeruginosa infection, he said.

Experts said doctors face a Catch-22 with these tiny patients. They can't live without medical interventions, but such steps can increase their risks of other problems.

"Those infants have no chance at survival without all the types of invasive devices that they have," said Dr. William Jarvis, an expert in hospital infections who previously worked at the CDC. "But those devices obviously place those patients at risk, because they are bypassing the normal body defense mechanisms."

The bacterium is hardy and like the more familiar Staphylococcus aureus, or staph can develop resistance to common antibiotics. Experts recommend that infected patients be isolated from others and that units known to harbor the bacterium receive deep cleanings.

Since Nov. 30, 33 patients have been treated in White Memorial's neonatal unit. Of the five babies who were infected, three died, Lopez said, but only one death appears to have been caused by the infection. Eighteen babies showed no signs of the bacterium. The remaining 10 had colonies of P. aeruginosa in their noses or rectums but no signs of infection.

Thirteen babies remain in the neonatal intensive care unit, Lopez said. The 28-bed unit is in a specialty care tower that opened in April.

Hospital officials said they are seeking outside reviews of all deaths in the neonatal unit since Nov. 30.

Other such outbreaks

Several outbreaks of P. aeruginosa have been identified previously in neonatal nurseries around the country.

From 1997 to 1998, 16 newborns died at Children's Hospital of Oklahoma. An investigation found that the bacterium had been found under the fingernails of two nurses, although researchers said they were unsure if that was the mode of infection.

In 1997, Children's Hospital Boston had to close its neonatal unit after four newborns died from P. aeruginosa infections.

After a 1999 P. aeruginosa outbreak in which five infants were sickened and one of them died, Prince George's Hospital Center in Maryland hired a full-time technician just to clean equipment in the neonatal unit. It has not seen an outbreak since, said Abdul Zafar, director of infection control for the system that runs the hospital.

Mascola of L.A. County said her agency did not release information on the outbreak at White Memorial before the hospital came forward Friday, because there was no risk of harm to the general public.

"We don't go public with any outbreak unless its something that the public needs to know about that's going to affect their health," she said.

According to the CDC, about 2 million patients suffer hospital-acquired infections annually, accounting for 90,000 deaths and $4.5 billion in healthcare costs.]]> http://www.yourlawyer.com/articles/read/12219 Sun, 29 Oct 2006 00:00:00 -0700 http://www.yourlawyer.com/articles/read/12219
At present, 22 patients most of them elderly are still sick with Clostridium difficile-associated disease at the Centre hospitalier Honore Mercier. The superbug is suspected to be lurking on five floors of the building, despite the fact housekeeping staff have twice washed down patient rooms with bleach.

The outbreak is baffling authorities because it comes as rates of C. difficile infections have been declining across Quebec, especially in the Montreal region.

Quebec's top public health officer, as well as a leading expert on C. difficile, dismissed claims yesterday by the hospital that an entirely new, hypervirulent strain has emerged in St. Hyacinthe, about 65 kilometres east of Montreal.

Rather, a lack of infection-control measures is probably to blame, suggested Mark Miller, head of a national surveillance group on C. difficile for the Public Health Agency of Canada. Miller said the hospital has probably been hit with a strain called NAP1/027 the same one that has circulated in Quebec since 2004.

That strain is 20 times more toxic than older strains of C. difficile and has directly or indirectly caused the deaths of 2,000 Quebecers.

"With the strain we have here in Quebec, there's no room for errors and no room for being lax," Miller said.

"You have to have excellent infection control all the time. You have to have great housekeeping all the time. If you become lax, the hospitals have shown that this strain causes outbreaks."

The infections started occurring in the 202-bed hospital on July 23 a couple of months after extensive renovations were undertaken to eliminate a fungus that was discovered in the walls.

Ghislaine Archambault, the hospital's communications director, said workers are in the process of disinfecting half the building. What's more, visits have been limited to one person per patient and children under 2 are not allowed in the hospital. Visitors are also advised to wash their hands before entering the hospital and after seeing patients.

"We want to ask the public to help us," Archambault said.

"We'll get through this."

Patients who are sick with C. difficile are being isolated. Certain pieces of equipment have been sterilized, curtains have been replaced and furniture is not being moved around.

Archambault said the hospital has faced two outbreaks the first in August and the second in recent weeks. Housekeeping staff scoured the hospital after the first outbreak.

Proper sanitation is good but is not enough, Miller said. Early diagnosis and treatment of C. difficile diarrhea must be made, and patients must be isolated without delay, he added. If those measures are not carried out immediately, an outbreak will occur, he said.

Across the province, the rate of C. difficile infections in large hospitals was eight per 1,000 admissions last month. That's down from a province-wide rate of 24 at the height of the epidemic in 2004.

At Montreal's Jewish General Hospital where Miller works as chief of infectious diseases the rate of infection dropped last month to its lowest level in 13 years.

For smaller hospitals, the average rate last month was four C. difficile cases per 1,000 admissions.

"It continues to improve every month," Miller said, the exception being St. Hyacinthe.

Horacio Arruda, provincial director of public health, said he doubts Honore Mercier has been beset by a new strain.

"It's clear that if you don't react fast to an outbreak, you'll get more cases," he said, adding he's satisfied with the hospital's measures.

"If you look at hospitals in Quebec, there are some that have seen increases and others that have seen decreases," said Jacques Bisson, of the Association to Defend Victims of Nosocomial Infections. "It all depends on how a hospital manages the problem of nosocomial infections and how they keep up with proper hygiene and prevention."

The provincial government is monitoring the situation at the hospital, said Isabelle Merizzi, an aide to Health Minister Philippe Couillard. "We have confidence in the rapid response by the hospital," Merizzi said.

It's doubtful the C. difficile bacterium was a direct cause of death in all nine patients at the hospital. Some of the patients were suffering from multiple illnesses, Archambault said, and C. difficile was a contributing factor in their deaths.

After initially playing down the C. difficile epidemic, the provincial government last year invested $25 million to fight hospital-acquired infections.

Similarly virulent strains of C. difficile have caused outbreaks in four U.S. states as well as in Britain and the Netherlands.]]> http://www.yourlawyer.com/articles/read/12090 Sat, 05 Aug 2006 00:00:00 -0700 http://www.yourlawyer.com/articles/read/12090
The Health Department since January has collected and posted on its Web site infections from Clostridium difficile, an intestinal bug acquired at hospitals and nursing homes. The state last week issued an interim report detailing rates at individual hospitals. The report showed about 14 percent of hospitals had not followed reporting requirements.

Rick Sites, legal counsel for the Ohio Hospital Association, said some data submitted by hospitals is missing. Sites said he didn't know how much information was lost, but he said the number appeared to be significant.

"We want to work closely with [the Health Department] on this issue and solve it," Sites said. "I think the reporting process needs to be studied."

Department spokesman Jay Carey said Friday that there is no problem with the computerized reporting system. Carey said that in some cases local health departments, which take the information from hospitals and enter it in the state system, didn't save data or enter it correctly.

"I think it was more an operator deal than a software glitch," said Carey, adding that another report will be issued this month.

"Some of the data wasn't in the right place at the right time to be in the July report. It will be in the August report," Carey said.

A virulent strain of C. diff has become a lethal public health threat responsible for outbreaks in Ohio and other states. The infections strike mostly elderly patients and those given antibiotics, which destroy protective natural bacteria in the intestines.

Hospitals say they have stepped up prevention efforts. But taming the bug has been a challenge for infectious-disease experts.

Last week, the Health Department reported about 3,000 C. diff infections at Ohio hospitals from January through June. The agency for the first time established rates, based on patient volume, to give hospitals a benchmark for gauging infections over time.

Some say public reporting motivates hospitals to improve infection control, but six months of data is not enough to single out facilities.

Sites, of the hospital association, said he had asked the Health Department to delay the report because of reporting problems.

Kevin Miller, president and chief executive of Ashtabula County Medical Center, said in an e-mail that he was told in July his hospital had not reported required data. But the hospital reported regularly and the city health department confirmed that it gave the data to the state, he said.

"It, therefore, makes me question the accuracy of the entire database," Miller wrote Friday.

Likewise, Lake Hospital System reported cases that the county health department sent to the state, said hospital spokeswoman Julieann Strogin. But the state report shows data missing for both of the system's hospitals.

"Why the state hasn't received it, I have no idea," Strogin said.
]]> http://www.yourlawyer.com/topics/overview/clostridium_difficile Sat, 05 Aug 2006 00:00:00 -0700 http://www.yourlawyer.com/topics/overview/clostridium_difficile Clostridium Difficile
Clostridium difficile has become a common infection control problem in hospitals and healthcare facilities. Clostridium difficile is a bacterium that affects your intestines. New versions of this bacterium produce 20 times the toxin of the older version. When clostridium difficile takes over the toxins attack your intestinal wall and left untreated may cause ulcerations. Antibiotic usage is usually the initial cause of developing this disease. Additionally, antibiotics are usually the cause of recurrent cases of Clostridium difficile. An estimated 400,000 case of severe diarrhea are associated to clostridium difficile each year.

Symptoms & Diagnosis
Clostridium difficile symptoms may include diarrhea and cramping at first. The later stages are commonly flu-like symptoms of weakness, dehydration, fever, nausea, vomiting. In the advanced stages, individuals may have blood in their stool. Lab tests examine stool samples to determine whether an individual might have a Clostridium difficile infection. A gastroenterologist is the main specialist that handles this illness because they deal with illnesses of the gastrointestinal tract (stomach & intestines). The gastroenterologist may perform a colonoscopy to assess the damage to your intestines and the presence of the Clostridium difficile.

Free Lawsuit Case Consultation
If you or a loved one has suffered from a hospital-borne bacterial infection you may have valuable legal rights. Complete the free case evaluation form on the right of this page to have your case immediately evaluated by a qualified attorney. If you prefer call Parker & Waichman, LLP, at 1-800-LAW-INFO (1-800-529-4636) 24 hours per day.]]>