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Deadly Stomach Bacteria Menaces Hospitals, Nursing Homes
11-12-08
T
he Bacteria, Clostridium difficile, responsible for severe intestinal distress,
is much more common in the nation’s hospitals and nursing homes than previously
thought, according to a recent survey of hundreds of hospitals across the United
States.
The Association for Professionals in Infection Control and Epidemiology asked
about 650 hospitals to choose any one day from this past summer (May through
August) and review medical data for that day to identify C. difficile infection.
The survey identified 1,443 patients infected with the bug, about 70% of whom
were past the age of 60.
The survey suggests 13 of every 1,000 hospital patients is infected with the
bacterium, or about 7,100 patients on any given day. This estimate is much
higher, by as much as 6.5 times to 20 times higher, than previous estimates.
The C. difficile bacteria live in the colon and cause diarrhea. A severe
infection can lead to colitis, which can be deadly, especially in elderly
patients. Recent outbreaks proved fatal to as many as 100 patients in some
hospitals.
The association revealed its survey findings at a medical conference recently
held in Orlando, Florida. The research team urges hospitals and nursing homes to
be more aware of this potentially deadly bacterium, which is becoming
increasingly resistant to antibiotics. Recommended steps to control infection
include more stringent cleaning methods, including the use of bleach as a
disinfectant, and isolation of infected individuals.
Comments:
Here is The Lowdown on this bacteria:
The cause:
Commonly used heartburn drugs appear to be contributing to the rapid increase
of community-acquired Clostridium difficile diarrheal infection.
Suppression of gastric acid with proton-pump inhibitors drugs like Prilosec (omeprazole)
or Nexium (esomeprazole) is associated with a two- to threefold increase in the
risk of community acquired Clostridium difficile, according to researchers here.
The finding supports the hypothesis that the mechanism of increased C. difficile
risk is related to the degree of gastric acid suppression, Sandra Dial, M.D.,
M.Sc., of McGill University and colleagues reported in the Dec. 21 issue of the
Journal of the American Medical Association.
Analysis of medical records from patients treated by general practitioners in
England found that the incidence of C. difficile diagnosed by GPs jumped from
less than 1 case per 100,000 population in 1994 to 22 cases per 100,000 in 2004.
That increase is mainly due to the increased use of gastric acid suppressors,
wrote Dr. Dial and colleagues.
The adjusted relative risk for current proton pump inhibitor exposure was 2.9
and the adjusted relative risk for current H2 -receptor agonist exposure was
2.0. Current exposure to NSAIDs, but not aspirin, was also associated with a
slight increase in risk of C. difficile. Proton pump inhibitors more effectively
suppress gastric acid than H2 -receptor agonists.
Decreased gastric acidity, they wrote, is "a known risk factor for other
infectious diarrheal illnesses such as travelers' diarrhea, salmonellosis, and
cholera."
The concluded, "Acid-suppressive agents are among the most frequently prescribed
medications in the United Kingdom and North America, and it is in this context
that the contribution of these agents by potentially increasing the pool of
susceptible hosts to the increasing rates of [C. difficile-associated disease]
need to be considered and more completely characterized."
C. Difficile is usually considered a nosocomial infection, but in this analysis
the researchers identified 1,233 cases among patients who had not been
hospitalized in the year prior to diagnosis. Those 1,233 cases account for 74%
of the 1627 cases of C. difficile identified in the General Practice Research
Database.
The researchers compared cases with age-matched controls. Four hundred of the
1,233 cases were diagnosed by clinical symptoms and 833 were identified by
positive toxin assay.
The mean age of patients with community-acquired C. difficile was 71 and most of
the cases were women. Other factors associated with C. difficile were history of
renal failure, inflammatory bowel disease, malignancy, and methicillin-resistant
Staphylococcus aureus-positive.
The symtoms:
Clostridium difficile, (also known as CDF/cdf', or 'C. diff') is a species of
bacteria of the genus Clostridium which are Gram-positive bacilli, anaerobic,
spore-forming rods (bacillus).C. difficile is the most significant cause of
pseudo membranous colitis. It is a severe infection of the colon, often
happening after normal gut flora is eradicated by use of antibiotics. The C.
difficile bacteria, which naturally reside in the body, become overgrown. A C.
difficile overgrowth is harmful because the bacterium releases toxins that
cause:
* Bloating and constipation
* Diarrhea with abdominal pain
* Severe diarrhea with mucus and blood present in feces and characterized by
body aches and severe abdominal pain caused from ulcerated intestines.
The latent symptoms often mimic some flu-like symptoms. Treatment is performed
by stopping current treatment and commencing specific anticlostridial
antibiotics, e.g. metronidazole or Vancomycin.
Bacteriology
Individual drumstick shaped C. diff bacilli seen through electronmicroscopy
Clostridia are motile bacteria that are ubiquitous in nature and are especially
prevalent in soil. Under the microscope after Gram staining, they appear as long
drumsticks with a bulge located at their terminal ends. Clostridium difficile
cells are Gram positive and show optimum growth on blood agar at human body
temperatures in the absence of oxygen. When stressed, the bacteria produce
spores which tolerate extreme conditions that the active bacteria cannot
tolerate.
First described by Hall and O'Toole in 1935, "the difficult clostridium" was
resistant to early attempts at isolation and grew very slowly in culture.
C. difficile is a commensal bacterium of the human intestine in a minority of
the population. Patients who have been staying long-term in a hospital or a
nursing home have a higher likelihood of being colonized by this bacterium. In
small numbers it does not result in disease of any significance. Antibiotics,
especially those with a broad spectrum of activity, cause disruption of normal
intestinal flora, leading to an overgrowth of C. difficile, which flourishes
under these conditions. This leads to pseudo membranous colitis.
C. difficile is resistant to most antibiotics. It is transmitted from person to
person by the fecal-oral route. Because the organism forms heat-resistant
spores, it can remain in the hospital or nursing home environment for long
periods of time. It can be cultured from almost any surface in the hospital.
Once spores are ingested, they pass through the stomach unscathed because of
their acid-resistance. They change to their active form in the colon and
multiply.
It has been observed that several disinfectants commonly used in hospitals may
fail to kill the bacteria, and may actually promote spore formation. However,
disinfectants containing bleach are effective in killing the organisms. However
a safer silver based disinfectant is available. Hospitals use bleach because it
is cheap.
Toxins
Pathogenic C. difficile strains produce various toxins. The most
well-characterized are enterotoxin (toxin A) and cytotoxin (toxin B).These two
toxins are both responsible for the diarrhea and inflammation seen in infected
patients, although their relative contributions have been debated by
researchers. Another toxin, binary toxin, has also been described, but its role
in disease is not yet fully understood.[5]
Role in disease
With the introduction of broad-spectrum antibiotics in the latter half of the
twentieth century, antibiotic-associated diarrhea became more common. Pseudo
membranous colitis was first described as a complication of C. difficile
infection in 1978,[6] when a toxin was isolated from patients suffering from
pseudo membranous colitis and Koch's postulates were met.
Clostridium difficile infection (CDI) can range in severity from asymptomatic to
severe and life threatening, and many deaths have been reported, especially
amongst the aged. People are most often infected in hospitals, nursing homes, or
institutions, although C. difficile infection in the community, outpatient
setting is increasing. Clostridium difficile associated diarrhea (aka CDAD) has
been linked to use of broad-spectrum antibiotics such as cephalosporins and
clindamycin, though the use of quinolones is now probably the most likely
culprit; quinolones are frequently used in hospital settings. Frequency and
severity of C. difficile colitis remains high and seems to be associated with
increased death rates. Immuno-compromised status and delayed diagnosis appear to
result in elevated risk of death. Early intervention and aggressive management
are key factors to recovery.
The rate of Clostridium difficile acquisition is estimated to be 13% in patients
with hospital stays of up to 2 weeks and 50% in those with hospital stays longer
than 4 weeks.
Increasing rates of community-acquired Clostridium difficile-associated
infection/disease (CDAD) have also been linked to the use of medication to
suppress gastric acid production: H2-receptor antagonists increased the risk
twofold, and proton pump inhibitors threefold, mainly in the elderly. It is
presumed that increased gastric pH, (alkalinity), leads to
decreased destruction of spores.
Diagnosis
In order to prevent complications, clinicians often begin treatment based on
clinical presentation before results have come back. Knowledge of the local
epidemiology of intestinal flora of a particular institution can guide therapy.
Prevention/Treatment:
Many persons will also be asymptomatic and colonized with Clostridium difficile.
Treatment in asymptomatic patients is controversial, also leading into the
debate of clinical surveillance and how it intersects with public health policy.
It is possible that mild cases do not need treatment.
Patients should be treated as soon as possible when the diagnosis of Clostridium
difficile colitis (CDC) is made to avoid frank sepsis or bowel perforation.
Besides avoiding Clostridium difficile by not taking antacids, proper hand cleaning, proper bathroom cleaning and habits, and staying out of hospitals you can help your intestinal tract become inhospitable to it.
Having a intestinal tract full of friendly bacteria keeps Clostridium difficile from taking hold there. Eat a healthy diet low in simple sugars and artificial chemicals as well as consuming cultured foods and Bella Mira Perfect Flora HSO's. Studies have shown that Clostridium difficile wont grown in an alkaline environment. Well neither will most disease. Eat in moderation: meat, cheese and dairy, eat 50 to 75% of your daily food intake in fruits and vegetables and juices, consume no grains, no simple sugars or artificial sweeteners and drink pure water. If these steps aren't enough than add Bella Mira PH Rescue to your daily regimen.
Should you become ill with Clostridium difficile here are some things to try. However should you get dehydrated, run a high fever, have immense pain, or are not improving; seek medical attention immediately!
Bentonite, Zeolite or Activated Charcoal: May be beneficial in easing pain and bloating as well as removing toxins.
Silver Biotics: Ionic Colloidal Silver is one of the strongest Antibiotics known to man and can be combined with any other antibacterial regimen. Ionic Colloidal Silver can be taken daily and will not harm friendly bacteria or cause antibiotic resistance. Silver Biotics action is physical not microbial and microbes cannot become immune!
Antibacterial Essential Oils: Click the link and they will all be listed:
Food Grade Peroxide: 1 drop of 35% food grade peroxide in 16 oz of water 1-3 times a day.
Ozonated water: This may be drunk or used as an enema if you have it available.
Bella Mira Perfect Flora HSO's: To kill the bad bacteria and repopulate the good bacteria.
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