C. diff News






Recent Updates
Recent Updates Treatment Options Funders National Advisory Council Register For C. Diff Gala Tiara Davis

C. Diff Stories

Teresa Mustain

MaryAnn Dillon

Ricky Spiese

Tiara Davis

Pastor Vic

Recent Blog Posts

Resources

Feed Entries

C. diff News

Novel Minimally Invasive Surgery Tames Fulminant C. difficile

BOCA RATON, FLA. – For patients with fulminant Clostridium difficile colitis, minimally invasive temporary loop ileostomy with colonic lavage may offer a novel life- and colon-saving alternative to colectomy.

In a series of 42 consecutive patients with severe complicated C. difficile colitis who underwent the surgery, 30-day mortality was only 19% and 39 patients (93%) preserved their colon, Dr. Brian Zuckerbraun reported at the annual meeting of the American Surgical Association.

This 19% mortality was impressively less than the 50% rate in 42 consecutive historical controls with similar Acute Physiology and Chronic Health Evaluation (APACHE) II scores who underwent subtotal colectomy at the same medical center just prior to introduction of the novel, less invasive operation. And the 50% mortality rate is on the low end of reported series, noted Dr. Zuckerbraun of the University of Pittsburgh.

"This approach may prove to be a better alternative to colectomy, because the colon is usually viable and can recover," he said. "Loop ileostomy and colonic lavage should be considered in all patients with severe complicated C. difficile colitis."

"Also, what we're finding now because of our outcomes and the smaller insult of this therapy compared to colectomy is that our medical colleagues are willing to consult us earlier in the care of these patients. They're not just thinking of surgery as a salvage operation when all else has failed," Dr. Zuckerbraun noted.

His presentation drew effusive audience praise.

Last Updated on Monday, 16 July 2012 10:24

Wrestling with Recurrent Infections

Clostridium difficile is evolving more robust toxicity, repeatedly attacking its victims, and driving the search for alternative therapies to fight the infection. The Scientist, May 1, 2011 As infectious bacteria go, Clostridium difficile may be one of the most vexing for researchers, clinicians, and patients alike. It spreads from person to person by ingestion of the bacterium’s spores, which can not only remain viable for long periods of time outside of a human host, but can withstand most common disinfectants. Within the body, the spores can survive the acidity of the stomach, germinating in the intestines where the bacteria release toxins that wreak havoc on the bowel, causing severe abdominal pain and diarrhea. And while the proper regime of antibiotics usually eliminates the infection, residual spores can remain, and the bacteria can reemerge with a vengeance weeks or months later. Recent estimates suggest that C. difficile infections (CDI) are on the rise, with up to 3 million cases in the United States each year,¹ and a third or more of CDI patients experience recurrence of the disease within the first month. Furthermore, recently evolved hypervirulent strains of C. difficile produce robust amounts of the disease-causing toxins, more spores, and additional surface proteins that help C. difficile persist in the gut and environment. Clearly, novel therapies are needed to combat the bacterium. The case of Gertrude Smith (whose name was changed to protect her identity) a generally healthy 82-year-old grandmother living in Rhode Island, illustrates just how difficult treating CDI can be. She went to her doctor complaining of a bad cough, low fever, and chest pain. Her doctor prescribed a 10-day course of antibiotics, a decongestant, and bed rest for a presumed chest infection. But within a week, Smith had developed profuse, watery diarrhea, and she returned to her doctor for help. She was eventually admitted to the ER, diagnosed with a C. difficile bacterial infection, and prescribed the recommended antibiotic treatment—500 milligrams of metronidazole three times a day for 10 days. Two weeks later, however, when she started a different antibiotic to address a persistent cough and chest pain, the diarrhea returned. Another cycle of metronidazole seemed to do the trick, until six months later, when her doctor prescribed yet another antibiotic for urinary symptoms, and she was once again hit with intolerable diarrhea. This time it was even more violent than before, and accompanied by acute abdominal pain. A double dose of traditional antibiotics temporarily quelled her symptoms, but four months later, the cycle started all over again. C. difficile was repeatedly attacking this otherwise healthy woman, with increasing intensity each time it struck.
Last Updated on Tuesday, 03 May 2011 07:01
Read more...

C. diff Colonization Accompanied by Changes in Gut Microbiota

Asymptomatic colonization by Clostridium difficile, absent the use of antibiotics, is common in infants and when it happens changes occur in the composition of the gut microbiota according to research published in the March 2011 issue of the Journal of Clinical Microbiology.

The adult human gut is an ecosystem containing several pounds of bacteria, including hundreds of species and more than 100 trillion individuals. A healthy microbial ecosystem protects the host against Clostridium difficile, which frequently colonizes the gut after its ecological balance has been disrupted by broad spectrum antibiotics, says Anne Collignon, of the University Paris Sud, Chatenay-Malabry, France.

Collignon and her colleagues examined the bacterial populations from fecal samples taken from 53 infants, 27 of them negative and 26 positive for C. difficile. Using a variety of analytic methods, her team showed that the C. difficile-negative infants' GI tracts contained the species, Bifidobacterium longum, which was absent from the C. difficile-positive infants, while the latter contained other species not present in the non-colonized guts, including Klebsiella pneumoniae. "We believe that this colonization is linked to an encounter with C. difficile spores, which are frequent in the environment, and a permissive microbiota," says Collignon.

"To reconstitute the ecological balance of the microbiota, and with that, the "barrier" effect, seems a very efficient way to combat C. difficile infections," says Collignon. "Our results suggest that Bifidobacterium species, which are used as probiotics, can participate in that barrier effect against C. difficile. But proof is necessary, for example, in gnotoxenic animal models (germ-free animals challenged with specific bacteria)." But she notes that another team of investigators has shown similar results in elderly people. "It is well known that following use of broad-spectrum antibiotics, the gram positive species decrease dramatically, and the bacteroides increase," she says. "Our study gives some clues to the microbiota composition allowing C. difficile colonization," she concludes in the paper.

Clostridium difficile is the most common cause of antibiotic-associated diarrhea and pseudomembranous colitis in adults, and infections are on the rise. Morbidity and mortality are high, and patients who are treated frequently relapse, as spores persist in the gut. Reconstituting the microbial ecology, with its barrier effect "seems a very efficient way to combat C. difficile infections," says Collignon, and recent studies suggest that this can be accomplished with probiotics and fecal transplantation.

Reference: C. Rousseau, F. Levenez, C. Fouqueray, J. Dore, A. Collignon, and P. Lepage, 2011. Clostridium difficile colonization in early infancy is accompanied by changes in intestinal microbiota composition. J. Clin. Microbiol. 49:858-865.

Last Updated on Monday, 16 July 2012 10:22

NYS Investigating C diff Outbreak at Hospital

Reported by Sean Carroll, ABC WHAM

Batavia, N.Y. --- The New York State Department of Health now confirms it is investigating an “outbreak” of potentially deadly bacteria that has or is infecting patients and United Memorial Medical Center in Batavia. UMMC confirms that as many as six patients at one point were being treated for the infection and as of Tuesday night three confirmed cases in patients exist and six additional patients are in the process of being screened.

"Oh we're monitoring them throughout the day," UMMC President and C.E.O. Mark Schoell said of the screening process and current cases. Schoell also tells 13WHAM News that the death of a “potential” C diff patient in the hospital’s care last month is still under investigation and the exact cause of death is currently unknown.

The family of another patient still being treated at UMMC tells 13WHAM News that their loved one’s condition is considered “grave” after she was diagnosed with a C diff infection just three days after surgery for a broken hip. According to her family Margaret Wagner, 86, was first admitted to UMMC on Saturday April 2nd and remains there 18 days later.

Last Updated on Wednesday, 20 April 2011 16:53

Recent Updates

Resources

Clostridium difficile is evolving more robust toxicity, repeatedly attacking its victims, and driving the search for alternative therapies to fight the infection.