Rising Foe Defies Hospitals' War On 'Superbugs'

Rising Foe Defies Hospitals' War On 'Superbugs'

WSJ, 9/17/08


Shortly after being admitted to a Cleveland-area hospital with severe abdominal pain, 52-year-old Maureen O'Hearn was transferred to intensive care. An intestinal infection had distended her abdomen so badly she appeared to be six months pregnant. To save her life, a surgeon had to remove her colon. The cause of Ms. O'Hearn's illness was an epidemic strain of Clostridium difficile -- C. diff for short -- that is fast emerging as one of the most dangerous and virulent foes in the war against antibiotic "superbugs." C. diff is spawning infections in hospitals in the U.S. and abroad that can lead to severe diarrhea, ruptured colons, perforated bowels, kidney failure, blood poisoning and death. Even as hospitals begin to get control of other drug-resistant infections such as MRSA, a form of staph, rates of C. diff are rising sharply, and a recent, more virulent strain of the bug is causing more severe complications. The Centers for Disease Control and Prevention estimates there are 500,000 cases of C. diff infection annually in the U.S., contributing to between 15,000 and 30,000 deaths. That's up from roughly 150,000 cases in 2001.

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Many patients get C. diff infections as an unintended consequence of taking antibiotics for other illnesses. That's because bacteria normally found in a person's intestines help keep C. diff under control, allowing the bug to live in the gut without necessarily causing illness. But when a person takes antibiotics, both bad and good bacteria are suppressed, allowing drug-resistant C. diff to grow out of control. As a result, hospitals are more closely monitoring and limiting their use of antibiotics. It's a strategy that also has shown some success in preventing the spread of other drug-resistant bacteria. Once patients do contract a C. diff infection, hospitals sometimes can treat them with certain "last ditch" antibiotics, such as vancomycin, but many patients relapse after treatment. Other efforts to stop the spread of C. diff include isolating infected patients; suiting workers and visitors from head to toe with scrubs, masks and gloves; and blasting patient rooms with super-strength bleach solutions. Milder "green" cleaners don't kill C. diff, undermining some hospitals' efforts to use these products.
Spreading Spores

One problem: C. diff produces spores that can dry out after cleaning and hang around on hospital cart handles, bed rails and telephones for months. Hand cleaning with alcohol, many hospitals' standard practice for keeping staff from spreading infection, can actually help disperse C. diff spores. Many hospitals now have special rules requiring staff to wash their hands with antibacterial soap when dealing with C. diff patients. Katie Lancey, lead environmental services aide at SSM St. Joseph Hospital West in Lake Saint Louis, Mo., says she spends up to an hour cleaning a room after a C. diff patient leaves. She wears protective garments and wipes down everything in the room with a bleach solution, including the TV, pillows, mattress and lower structure of the bed. "Anything you can think of, you make sure you wipe it down thoroughly," she says... The efforts, along with more careful use of antibiotics, have helped SSM St. Joseph reduce the rate of C. diff infections to 0.5 cases per 1,000 patient days currently from 2.5 cases in 2006, Dr. Hinrichs says.

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Ms. O'Hearn, the Cleveland-area patient, says she took an antibiotic for a sinus infection and then visited a nursing home, where she may have picked up the C. diff bug. During her hospital treatment, Ms. O'Hearn says she suffered an irregular heartbeat and dehydration, and required additional surgery to temporarily attach her small intestine to the abdominal wall to bypass the large intestine. "It was the worst nightmare that anyone could imagine," says Ms. O'Hearn, a nurse by training. Though she has returned to work and a more normal lifestyle, she continues to have digestive troubles, and must take medications to regulate her heart.

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One controversial strategy: fecal transplants. For one patient with recurrent C. diff, Kettering suggested a stool transplant from a relative, to help restore good bacteria in the gut. But Jeffrey Weinstein, an infectious-disease specialist at the hospital, says the patient "refused to consider it because it was so aesthetically displeasing.".. But C. diff can be fatal. Philadelphia radio personality Hy Lit, 73, contracted a C. diff infection at a rehabilitation center after being treated at a hospital owned by Main Line Health System last fall. He died in another Main Line hospital two weeks later. "It was a multiple train wreck, when the bug permeated his bloodstream and his kidneys failed," says his son, Sam Lit. "It was a tragedy to lose him like that."

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http://online.wsj.com/article/SB122160848756745487.html?mod=todays_us_personal_journal (subscription)

By Thomas G. Dolan
Radiology Today
Vol. 7 No. 10 P. 32

Infectious diseases, most notably methicillin-resistant Staphylococcus aureus (MRSA), as well as vancomycin-resistant Enterococcus (VRE), are wreaking havoc in the nation’s hospitals—and it’s getting worse, according to experts. The irony, according to some, is that they are almost entirely preventable....

Yet, there is a realistic solution available which, Farr says, is not rocket science or some new technology breakthrough, but rather is based on keeping hands and equipment clean, the same principles Holmes wrote about in 1842.

This approach has worked in other countries. “In Denmark, MRSA was causing one third of bloodstream infections,” Farr says. “It took them about a decade to bring it under control, to less than 1%, and they kept it under control at less than 1% for the next quarter-century. Similar dramatic results have been reported in the Netherlands, Finland, and western Australia.”

http://www.radiologytoday.net/archive/rt52206p32.shtml.

Lovely. I just finished taking antibiotics for Lyme Disease and I live on the other side of a nursing home; their dumpsters are always overflowing and practically in our back yard.

and use those towelettes to wipe everything that you touch in public. And, of course, wash your hands with soap and water whenever you come into your home.

I'm a vegetarian so I try to keep yogurt in the house. And after surviving countless flu seasons in cramped office spaces, I'm a bit germ-phobic.

I was taking doxycyclene, not penicillin, I wonder if that makes a difference?

Most of us have C. diff. in our bowels. Normal flora--other germs--keep it under control. Unfortunately, those normal flora are more susceptible to antibiotics than C. diff. is, so a long course of antibiotics can allow the C. diff. to flourish.

Most healthy people won't have a problem with it, but any diarrhea while you are on antibiotics should be suspect. C. diff. has a distinct odor and produces very mucusy stools. If you've been on antibiotic therapy and start having this type of stool with an outrageous stench (I could diagnose it the second I stepped off the elevator on a patient floor), call your doctor at once. It's nothing to play with outside the hospital.

A reasonable precaution is to eat yogurt with live cultures during antibiotic therapy. These bugs can help normalize your bowel although they're not a sure prevention.

It's easier treat if it's caught early. Just be alert if you're on antibiotics.

Jeebus H. Fukkin Christofferson, have they heard of yogurt?