BIDMC Experts Tackling Powerful Infection Affecting Patients Nationwide
By Michael Lasalandra
Beth Israel Deaconess Medical Center Correspondent
In recent years, hospitals and nursing homes across the country have been fighting a powerful germ that causes symptoms ranging from persistent diarrhea to life-threatening colon inflammation.
Clostridium difficile, also called C. difficile or “C. diff,” is a bacterium that almost exclusively affects hospital patients or nursing home residents. These infections have become more frequent, more difficult to treat and more severe, leaving doctors and hospital officials scrambling to find answers.
“It’s not clear why this is occurring so much,” says Dr. Thomas Lamont, chief of gastroenterology at Beth Israel Deaconess Medical Center and a leading authority on C. difficile. “It may be that the organism is becoming more virulent, more infectious.”
According to Lamont, the bug affects 10 to 15 percent of all patients in hospitals or nursing homes nationwide. “It is one of the most common hospital-acquired infections in the United States,” he says.
C. diff affects only those who have been on antibiotics and causes disease only in the colon or large bowel. It typically affects older patients and usually just those who have been in the hospital for two days or more. Still, tens of thousands are affected each year.
“Patients who take an antibiotic for something else become susceptible,” Dr. Lamont says, noting that the antibiotic destroys some of the intestinal flora -- helpful bacteria -- that actually protect the body from infection, at the same time that the drug is killing the harmful bacteria that it was prescribed to treat.
Mild symptoms of diarrhea may improve once patients stop taking the antibiotics that allowed them to become susceptible to C. diff in the first place.
Paradoxically, the treatment for persistent C. diff infection is a prescription for another antibiotic, usually metronidazole (Flagyl) or vancomycin (Vancocin), depending on the severity of symptoms. Most patients get better on the new antibiotic.
There is some evidence that probiotics -- organisms such as good bacteria and yeast -- may help prevent recurring C. diff infections, according to Dr. Lamont. These are contained in yogurt or available as capsules, usually without a prescription.
Infection with C. diff can cause symptoms ranging from mild to severe diarrhea, dehydration, fever, abdominal pain, colon inflammation, colitis, and even a hole in the large intestine that can be life-threatening if not surgically repaired in time. This condition -- a perforated bowel -- can spill bacteria from the intestine into the abdominal cavity, leading to peritonitis.
Doctors at BIDMC, led by Dr. Ciaran Kelly, another gastroenterologist, have been leading the research into C. diff. Kelly is working to develop a vaccine that seeks to prevent the infection. Early research is promising, according to Dr. Lamont. “That’s the good news,” he says.
In the meantime, prevention efforts are focusing on getting hospital staff to wash their hands with soap and water more frequently, he says. And doctors are being urged to prescribe antibiotics more cautiously, he notes.
But for now, C. diff remains a serious problem. “So far, the bug is winning,” Dr. Lamont says. “It still responds to Flagyl or Vancocin, but less well. And it is more severe. It is causing a lot of trouble.”
Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.
Posted March 2009
Beth Israel Deaconess Medical Center Correspondent
In recent years, hospitals and nursing homes across the country have been fighting a powerful germ that causes symptoms ranging from persistent diarrhea to life-threatening colon inflammation.
Clostridium difficile, also called C. difficile or “C. diff,” is a bacterium that almost exclusively affects hospital patients or nursing home residents. These infections have become more frequent, more difficult to treat and more severe, leaving doctors and hospital officials scrambling to find answers.
“It’s not clear why this is occurring so much,” says Dr. Thomas Lamont, chief of gastroenterology at Beth Israel Deaconess Medical Center and a leading authority on C. difficile. “It may be that the organism is becoming more virulent, more infectious.”
According to Lamont, the bug affects 10 to 15 percent of all patients in hospitals or nursing homes nationwide. “It is one of the most common hospital-acquired infections in the United States,” he says.
C. diff affects only those who have been on antibiotics and causes disease only in the colon or large bowel. It typically affects older patients and usually just those who have been in the hospital for two days or more. Still, tens of thousands are affected each year.
“Patients who take an antibiotic for something else become susceptible,” Dr. Lamont says, noting that the antibiotic destroys some of the intestinal flora -- helpful bacteria -- that actually protect the body from infection, at the same time that the drug is killing the harmful bacteria that it was prescribed to treat.
Mild symptoms of diarrhea may improve once patients stop taking the antibiotics that allowed them to become susceptible to C. diff in the first place.
Paradoxically, the treatment for persistent C. diff infection is a prescription for another antibiotic, usually metronidazole (Flagyl) or vancomycin (Vancocin), depending on the severity of symptoms. Most patients get better on the new antibiotic.
There is some evidence that probiotics -- organisms such as good bacteria and yeast -- may help prevent recurring C. diff infections, according to Dr. Lamont. These are contained in yogurt or available as capsules, usually without a prescription.
Infection with C. diff can cause symptoms ranging from mild to severe diarrhea, dehydration, fever, abdominal pain, colon inflammation, colitis, and even a hole in the large intestine that can be life-threatening if not surgically repaired in time. This condition -- a perforated bowel -- can spill bacteria from the intestine into the abdominal cavity, leading to peritonitis.
Doctors at BIDMC, led by Dr. Ciaran Kelly, another gastroenterologist, have been leading the research into C. diff. Kelly is working to develop a vaccine that seeks to prevent the infection. Early research is promising, according to Dr. Lamont. “That’s the good news,” he says.
In the meantime, prevention efforts are focusing on getting hospital staff to wash their hands with soap and water more frequently, he says. And doctors are being urged to prescribe antibiotics more cautiously, he notes.
But for now, C. diff remains a serious problem. “So far, the bug is winning,” Dr. Lamont says. “It still responds to Flagyl or Vancocin, but less well. And it is more severe. It is causing a lot of trouble.”
Above content provided by Beth Israel Deaconess Medical Center.
For advice about your medical care, consult your doctor.
Posted March 2009
