Fears of a new bacterial threat

Excerpt taken from an article by Shari Roan, LA Times Staff Writer, October 23, 2006

While infections with drug-resistant staph and E. coli have been grabbing headlines and public attention in recent months, a new bacterial threat has quietly emerged. Typically seen in elderly hospitalized patients, the illness has begun popping up in the community at large — specifically among healthy younger people, including children and pregnant women.

The bacterium responsible, called Clostridium difficile, or C. difficile, has been blamed for recent outbreaks of intestinal infections in about 10 states, as well as Canada and Europe. Patients become ill with frequent bouts of watery diarrhea, fever and abdominal tenderness. In rare cases, the infection can progress to sepsis, colitis and even death. The strain, identified as NAP1, appears to be more virulent than its predecessor.

C. difficile is found in feces and is one of the leading causes of hospital-acquired diarrhea. People become infected by touching items or surfaces contaminated with the bacterium and then transmitting it to their mouths. It gains ground when patients take antibiotics — often broad-spectrum antibiotics, such as clindamycin, penicillin and increasingly the class of drugs called fluoroquinolones. The drugs upset the balance of normal bacteria in the colon, killing good types of bacteria that protect the body.

In doing so, they allow C. difficile to flourish and begin releasing toxins that damage the intestines, says Dr. L. Clifford McDonald, a medical epidemiologist with the CDC who has studied C. difficile trends. Two primary toxins, toxin A and toxin B, cause the diarrhea and inflammation. The NAP1strain may also explain why more cases are being identified outside of the hospital and in people who haven't taken antibiotics.

The use of proton pump inhibitors for gastric reflux disease has been proposed as a possible cause of the C. difficile upsurge because the medications can have an antibiotic effect and can lower acid levels in the gastrointestinal tract. The acid would normally kill harmful bacteria. But the hypothesis is controversial.

Researchers are also stumped as to why children, and pregnant and postpartum women and other gynecological patients, seem particularly likely to be affected. A study in this month's issue of the journal Clinical Infectious Diseases found a 6.7% rate of C. difficile in children admitted to an emergency room with severe diarrhea — far above the 1.9% rate found in a previous study of diarrhea among children in a community.

Anyone with diarrhea lasting more than three days and accompanied by a fever or blood in the stool should seek help. Proper hand washing is essential to reduce spread of the illness. Antibiotics should be prescribed only when clearly necessary.

"We hope all clinicians and patients will think about antibiotic use," McDonald says. "They are important and save lives, but they are not without risk. If there is a silver lining in the C. difficile problem, it might be just that. It brings a little closer to home that antibiotics can have severe consequences."

Bonnie - I have seen many clients with C. difficile and the common threads are that they have been on antibiotics and/or GERD (reflux) medication. While the aforementioned article mentioned the reflux meds as just theory, I have seen it clinically. If a physician from the CDC is speaking this strongly about the effect antibiotics have on normal gut bacteria balance, the public should take it seriously.

For ANYONE going on or have been on antibitoics, you must supplement with a high quality, high potency broad-spectrum probiotic to replenish destroyed beneficial gut bacteria. Yogurt and Kefir is not going to cut it.

For those on GERD/Reflux meds, try to minimize the length of time on them and get to the cause of the GERD through dietary modification. Besides lowering gut acid, which keeps pathogens at bay, GERD/Reflux meds also deplete essential vitamins and minerals.