Scary Intestinal Bug on the Rise in Hospitals

By Anastacia Mott Austin

There’s a scary new intestinal bug that causes severe diarrhea and sometimes lasts for months despite treatment, and it is growing more resistant to antibiotics over time.

Actually, it’s not a new bacterium but it has developed a particularly nasty version of itself that is extremely difficult to treat, causing thousands of deaths per year.

A recent outbreak of clostridium difficile, or C-diff, in hospitals in Canada led to a public outcry and a demand for better reporting of the disease. When hospitals reported higher numbers of fatal cases of C-diff than they had when the SARS outbreak occurred, the public became extremely concerned.

Cases in the United States are more prevalent in the northeastern states, though C-diff has been found in virtually every state of the country.

Not only is the illness becoming increasingly resistant to the few drugs still used to treat it, but it’s very infectious, which is why it’s such a problem in group settings like hospital wards and nursing homes. The spores can live on surfaces or in the air for months, even years, and are not killed by most common disinfectants or antibacterials.

In addition, two-thirds of the people who contract C-diff are elderly, because their immune systems tend to be compromised.

Testing for C-diff infection frequently comes back negative at first, but the symptoms combined with situational factors (i.e., arising immediately after a hospitalization or antibiotic treatment) can aid in proper diagnosis.

The primary symptom, frequent and very severe diarrhea, often begins to occur after the patient has completed a round of antibiotics. When antibiotics are used, "friendly" intestinal bacteria that help humans keep their bodies in balance are killed off, and the drug-resistant bad-guy bacteria take over. In the worst cases, ulceration of the intestinal wall and colon can occur, along with bloody diarrhea.

In some people, it can take months for treatment to be effective. For others, it’s the final straw in an already weakened state, and the infection becomes fatal. Unfortunately, since hospital patients are already there for some type of medical problem or procedure, adding a virulent C-diff infection is the last thing they need.

Even for those successfully treated by the few remaining effective drugs, relapse is common, and as many as 25% of patients will contract an infection again within two months.

Concern among medical professionals is increasing, as they worry what will happen when and if C-diff becomes completely resistant to antibiotic treatment. Some alternative treatments, such as supplementing with lactobacillus acidophilus (the "friendly" cultures found in most yogurts), have been successful.

But the fast-growing disease is definitely something to be concerned about. If you haven’t heard of C-diff yet, you likely will.

How can you avoid this terrible ailment? First, avoid checking into a hospital if at all possible. If you need to stay at a hospital, find out in advance what they are doing to combat the spread of C-diff. Many hospitals now isolate patients with the disease and use stringent measures to avoid contagion between patients.

Second, think twice the next time you feel you need to take antibiotics, since their use is directly related to the proliferation of the illness. Many conditions will resolve on their own without antibiotic use. If you do need to take antibiotics, make sure to complete the full course to avoid drug resistance, and immediately begin supplementing with acidophilus (which can be found at local health food stores and in many grocery stores).

A new study published this month in the aptly named Journal of Emerging Infectious Diseases reports that cases of C-diff more than doubled between the years of 2000 and 2005.

Even more alarming, a study released last year indicated that a newer, stronger version of C-diff was on the rise. Regular strains of C-diff produce two toxins that cause the intestinal problems in infected people. The new strain, called NAP-1, produces 23 times more of the first toxin and 16 times the amount of the second. This explains the sharp rise in deaths from C-diff, say experts.

"This rapid pace of growth is alarming," writes Marya Zilberberg and her colleagues at the University of Massachusetts, authors of the recent study. "If this rate of rise, along with the increase in virulence and diminished susceptibility to antimicrobial drug treatments, persists, C-diff associated disease will result not only in a considerable strain on the U.S. healthcare system but also in rising numbers of deaths related to this disease."