Wednesday, February 15, 2017

Gaining Ground on Clostridium difficile Infections

One of the most dangerous of all gut bacteria is a bacterium called Clostridium difficile.  C. difficile can cause diarrhea so severe that it can lead to death, especially in older patients in hospitals and nursing homes, in whom it is most common.  To make matters worse, it is difficult to treat because it is resistant to most antibiotics.  Although it is present in most people, its population is normally kept in check by the presence of other "good" bacteria, which tend to out-compete it.  But when nearly all of a person's gut bacteria are wiped out, for example when the person is given antibiotics, C. difficile can reproduce explosively, overwhelming the body's defenses.

Although C. difficile was first identified over 80 years ago, it wasn't until this century, when a strain of C. difficile developed resistance to most antibiotics, that the bacterium became a serious clinical problem.  In a 2015 study published in the New England Journal of Medicine, the Centers for Disease Control and Prevention (CDC) reported that in 2011, C. difficile infections caused about 15,000 deaths directly and contributed indirectly to another 14,000 deaths.

But now health officials are seeing signs that C. difficile infections may be on the decline.  One of the key factors may be our more enlightened use of antibiotics; i.e., only when truly needed.  By reducing the indiscriminate use of antibiotics, especially in hospitals and nursing homes, there have been fewer opportunities for C. difficile to gain a foothold.  But there are other signs of hope, too.  Several vaccines are in the works, and Merck has a new (and expensive) drug called Zinplava that is at partially effective at reducing recurrent infections.  Even fecal transplants (to reintroduce competing bacteria; see this blog, Feb. 23, 2014) seem to help, though these are still just in the experimental stage.

Progress is being made, though sometimes it seems slow.  All we can do is keep trying.

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