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C. diff Epidemic Likely to Get Worse

Experts Say Cases of the Diarrhea Bug Are Now in All 50 States
By
WebMD Health News
Reviewed by Louise Chang, MD

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Oct. 30, 2008 (Washington, D.C.) -- The nation's epidemic of the nasty superbug Clostridium difficile, or C. diff, will likely get worse before it gets better, says a panel of experts.

Cases of the potentially dangerous diarrhea bug have now been seen in all 50 states, says L. Clifford McDonald, MD, of the CDC's 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.

Most cases of C. diff occur in people taking antibiotics. Spores enter the body through the mouth, which is the entryway for the gastrointestinal tract. The overgrowth of the C. diff bacteria in the colon, or large intestine, can cause diarrhea, which is often severe and accompanied by intestinal inflammation known as colitis.

Antibiotics can kill "good" bacteria in the colon that keeps C. diff at bay, explains M. Lindsay Grayson, MD, vice chairman of the committee that chose which studies to highlight at the meeting and an infectious diseases specialist at Austin Health in Melbourne, Australia.

Infection often runs rampant in hospitals and nursing homes, where patients and health care workers are in close proximity. Typically, the bug can't be wiped out by standard cleaning agents, he tells WebMD.

The experts spoke here at a joint meeting of the American Society for Microbiology and the Infectious Diseases Society of America.

Deaths Up Fivefold

Hospital discharge data reveal a fourfold increase in C. difficile rates since 2001, according to McDonald. Associated deaths have increased fivefold, he says.

Overall, C. diff is responsible for tens of thousands of cases of diarrhea and at least 5,000 deaths a year, according to the CDC.

The Infectious Diseases Society of America and the Society of Healthcare Epidemiology of America have published guidelines aimed at reducing the spread of the superbug. Among its recommendations are to avoid overuse of antibiotics, use bleach to clean surfaces during outbreaks, don gowns and gloves when caring for patients, and follow strict hand washing and other good hygiene practices.

The antibiotics vancomycin and metronidazole are typically used to treat the infection, but the drugs are failing to help many patients, especially those with repeat bouts, says Dale Gerding, MD, of Hines VA Hospital in Chicago.

"We've had the same therapies for 30 years and new ones are desperately needed," he tells WebMD.

One procedure that does seem to work, but has been slow to catch on in the U.S., is a "fecal transplant," Gerding says.

Doctors obtain a stool sample from a healthy relative of the patient, typically a spouse, filter the sample, and infuse it into the C. difficile patient, typically via a nasal tube.

The idea is that the fresh stool will restore whatever bacteria were depleted from the infected person's intestines by antibiotic treatment, Gerding says.

"It's highly effective, with success rates of about 90%. But hospital safety boards are reluctant to approve its use as they fear other pathogens could also be introduced [into the patient]," he says.

In Europe, especially Scandinavia, the procedure has gained better acceptance, Gerding says.

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