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C. Diff: New Threat From Old Bug

Epidemic Gut Infection Causing Rapid Rise in Life-Threatening Disease

Nasty New <em>C. Diff</em> Bug continued...

In addition to making about 20 times more of the two toxins produced by normal C. diff, the new strain makes a new, third toxin similar to a toxin seen in other disease-causing bacteria.

According to the CDC, the new strain of C. diff already has invaded at least 19 U.S. states: California, Connecticut, Florida, Georgia, Illinois, Maine, Maryland, Massachusetts, Missouri, New Jersey, New York, North Carolina, Ohio, Oregon, Pennsylvania, Tennessee, Texas, Washington, and Wisconsin.

It has spread throughout Canada and, according to McDonald, is "wreaking havoc" in England, the Netherlands, Belgium, and France.

Vancomycin to the Rescue?

As it happens, Zar had been studying the best way to treat C. diff infection when the current epidemic broke out. In a clinical trial, he's been comparing the currently recommended treatment for C. diff -- the antimicrobial drug Flagyl -- with a powerful antibiotic called vancomycin.

Vancomycin is known to work against C. diff. But doctors have been reluctant to use it -- not only because it costs more, but also because it's the last line of defense against a number of other nasty infections. Once it's in common use, it's only a matter of time before many of these germs become vancomycin resistant.

However, Zar's team reported to the IDSA that vancomycin cures severe C. diff disease 97% of the time -- compared with a 76% cure rate for Flagyl.

"Fortunately, we've seen no vancomycin resistance in C. diff -- yet," Zar says. "But we know that the bug can develop resistance to this antibiotic."

Community Infections Spreading

McDonald isn't yet ready to blame all of C. diff's resurgence on the bad new strain. Nor is the CDC yet sounding the alarm over the community spread of C. diff. But his CDC team has documented a growing problem.

Together with Duke University researchers, McDonald's CDC team analyzed more than 1,200 C. diff cases treated at six North Carolina hospitals.

"The general picture is that about one in five cases of C. diff in North Carolina hospitals were community-associated -- we think community-acquired -- in people not hospitalized for at least three months, most of them not for two years," he says.

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