Thursday 25 January 2018

Cases of superbug Clostridium difficile increase

The most troubling cases of C. difficile infection, termed multiple recurring C. difficile infections (mrCDI), are becoming more common, according to a new university research study.

The study comes from the University of Pennsylvania School of Medicine and it highlights a concern within the U.S. healthcare network (made up of 40 million patient records). The data was drawn from a large, nationwide health insurance database. The big data analysis not only informs about the general Clostridium difficile rate (which affects over half a million U.S. citizens each year), it shows the extent of recurrent infections.

Clostridium difficile infection refers to a symptomatic infection due to the spore-forming bacterium. By being spore forming the organism is hard to kill. Symptoms of infection can include watery diarrhea, fever, nausea, and abdominal pain. Further complications can include pseudomembranous colitis, toxic megacolon, perforation of the colon, and sepsis.

Multiple recurring C. difficile infections raise concerns because recurrent infections increase the risk of death for already vulnerable patients. Reoccurrence also signals that attempts at eradication of this infection are failing. Furthermore recurrent cases also tend to involve more virulent strains of the bacterium. These risks have been described in an article for the journal Anaerobe headed “A case of multiple recurrence of Clostridium difficile infection with severe hematochezia in an immunocompromised host.”

The propensity of recurrence occurs in 15 to 35 percent of patients who initially respond to antimicrobial therapy. Due to the need to switch to different antibiotics, and the added complication of antibiotic resistance, the recurrent cases are especially difficult to treat and they contribute to significant morbidity and mortality and increased health care expenditures. Antibiotics called metronidazole, vancomycin, and fidoxamicin are often used to treat infections, but resistance can arise.

According to the new analysis, the reason for the sharp rise in mrCDI's incidence is uncertain; what is clear is that the cases are growing (rising by 43 percent over a recent ten year period). What the report does highlight is need for new approaches to treatment. An example of this is with fecal microbiota transplantation, where beneficial intestinal bacteria from one patient are infused into another to help out-compete the infective C. difficile.

This needs more study, however, according to Professor James D. Lewis from the University of Pennsylvania: “While we know that fecal microbiota transplantation is generally safe and effective in the short term, we need to establish the long term safety of this procedure."
Posted by Dr. Tim Sandle

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