MRSA Infection

Deadly infection an evolving threat

Link: Deadly infection an evolving threat.

Though her mother was in her 90s, Bright said, she was in essentially good health until a brief hospital admission started her decline — a yearlong, losing battle against a lethal intestinal infection caused by a microscopic organism called Clostridium difficile. Clinicians and public health officials refer to it casually as "C. diff." Though it’s been a problem for many years, they say, now it’s on the rise everywhere — not just in hospitals, nursing homes and other institutions, but even out in the communities where we live and work. A new strain seems to be evolving — more lethal, easier to spread, and harder to treat.

More at the link above

Detecting different strains of C Diff

Link: Applied and Environmental Microbiology.

    Clostridium difficile is a major spore forming environmental pathogen causing serious health problems in patients undergoing antibiotic therapy. Consequently, reliable and sensitive methods for typing individual strains are required for epidemiological and environmental studies. Ribotyping is generally considered the best method but fails to account for sequence diversity which might exist in intergenic 16S-23S rRNA spacer regions (ISRs) within and among strains of this organism. Therefore this study was undertaken to compare the sequence of each individual ISR in five strains of C. difficile to explore the extent of this diversity and see whether such information might provide the basis for more sensitive and discriminatory strain typing methods.

Support for those affected by virulent bug

Link: icBerkshire - Support for those affected by virulent bug.
       A SUPPORT group has been set up for people who have lost relatives through Clostridium difficile, the virulent bug which is sweeping through hospitals. C difficile has claimed the lives of three times as many patients as MRSA (methicillin resistant staphylococcus aureus), known as the superbug. C difficile infections can cause diarrhoea that contains blood and mucus, and can also lead to abnormal heart rhythm. Last month the Express highlighted the case of Gail Day of Ham Island, Old Windsor, who watched her mother, Joan Rowe, suffer an agonising death after contracting the bug. Mrs Day is convinced that her mother became infected while being treated for a broken hip at Wexham Park Hospital. Her biggest complaint is that at no point was she told by medical staff that her mother had C difficile.

The website is www.cdiff-support.co.uk

C Diff Hospital infection spreads, toughens

Link: Philadelphia Inquirer

   Just hours before the intense nausea hit, Robin Wach� was bragging to her friends about how good she felt after surgery to treat an intestinal infection.

Then the mother of three got the worst case of diarrhea ever. It lasted for weeks and was so severe she could hardly leave her Ambler home.

Wach�, 45, was stricken by Clostridium difficile, a sometimes deadly bacterium that has recently become more virulent and widespread, putting health officials on edge.

"The disease that is being seen is much more severe, and there is a new epidemic strain circulating nationally and internationally," said Neil Fishman, a University of Pennsylvania infectious-disease specialist.

The infection initially had been found mostly in hospitals and nursing homes.

An Inquirer computer analysis shows the number of hospital patients diagnosed with the infection is rising.

In Philadelphia and its Pennsylvania suburbs, the rate of patients diagnosed with C. diff, as the disease is known, shot up 42 percent from 1997 to 2003.

In New Jersey, the rate more than doubled between 1997 and 2004 to 9.5 cases per 1,000 hospital patients. In 2004, hospitals in New Jersey diagnosed 10,852 patients with the illness, up from 4,818 in 1997.

Nationwide, there were 178,000 C. diff patients in 2003, about a 60 percent increase since 1997, according to the National Hospital Discharge Survey.

C. diff is a leading cause of antibiotic-associated diarrhea and, until recently, was primarily seen as a problem confined to hospitals and nursing homes.

Now researchers have identified a strain that appears to have developed resistance to some antibiotics. Further, it may no longer be confined to hospitals.

"We need to figure out whether the community cases are increasing," said L. Clifford McDonald of the Centers for Disease Control and Prevention in Atlanta.

C Diff bacteria strain changes form - News

Link: News.

    A new version of a common intestinal bug is becoming more deadly and more easily transmitted, and Triangle medical professionals are at the forefront of the study.

Although medical workers have known the bacterium Clostidium difficile as a cause of diarrhea in hospitals and in people taking antibiotics, the Centers for Disease Control have put it under national surveillance for increased virulence.

While both humans and animals carry the bug, the animal strains have not seen a parallel increase in virulence.

According to David Damsker, community health lead physician of the Wake County Health Department, C. difficile is part of the "normal flora" of the intestinal tract. He said that when patients take antibiotics, they kill the other bacteria, allowing C. difficile to thrive.

"It's not like this is some weird bacteria that we don't know where it comes from," he said. "The problem is that there have been outbreaks of higher mortality strains, and cases in people who haven't taken antibiotics."

Quebec Research Team Unmasks Hypervirulent C. Difficile Strain

Link: Quebec Research Team Unmasks Hypervirulent C. Difficile Strain.

In March 2003, several Quebec hospitals noted a marked increase in the incidence of Clostridium difficile," says Dr. Vivian Loo, Chief of Microbiology at the MUHC and the study's principal investigator. "It became clear that we were all suffering similar outbreaks and decided to pool our resources and expertise to determine the extent of the problem, identify this strain and work towards improved prevention methods and treatments." This study reports the magnitude of this outbreak and incidence of severe disease. In addition, researchers used DNA fingerprinting by pulsed field gel electrophoresis to identify the Quebec predominant strain, which is similar to an epidemic strain that struck in the US, UK and Belgium. The research states that this new strain was responsible for over 80% of cases studied in Quebec, and suggests that the use of antibiotics in the hospitals assisted in the rapid spread of the bacteria. The researchers identified two factors that may potentially explain why this particular strain of Clostridium difficile was able to result in severe disease among patients. This research highlights the leading role that Quebec-based scientists are playing in international Clostridium difficile research. The collaborative efforts and complementary expertise among clinicians and basic scientists in the different hospitals and Quebec universities were instrumental in furthering the knowledge of this important health problem.

CDC: Deadly bacterial illness getting worse

Link: CDC: Deadly bacterial illness getting worse.

A deadly bacterial illness commonly seen in people on antibiotics appears to be growing more common -- even in patients not taking such drugs, according to a report published Thursday in a federal health journal. In another article in the New England Journal of Medicine, health officials said samples of the same bacterium taken from eight U.S. hospitals show it is mutating to become even more resistant to antibiotics. "I don't want to scare people away from using antibiotics. ... But it's concerning, and we need to respond," said Dr. L. Clifford McDonald, an author of both articles and an epidemiologist at the federal Centers for Disease Control and Prevention. "Hospitals need to be conducting surveillance and implementing control measures. And all of us need to realize the risk of antibiotic use may be increasing" as the bacteria continue to mutate, McDonald said. The bacterium is Clostridium difficile, also known as C-diff. The germ is becoming a regular menace in hospitals and nursing homes, and last year it was blamed for 100 deaths over 18 months at a hospital in Quebec, Canada. "What exactly has made C-diff act up right now, we don't know," McDonald said. The article published in the CDC's Morbidity and Mortality Weekly Report focused on cases involving 33 otherwise healthy people that were reported since 2003 in Pennsylvania, Ohio, New Jersey and New Hampshire.

Infection Control Today - Scientists Provide Insight Into Virulent Strain of Clostridium Difficile

Link: Infection Control Today

Using genotyping methods, the researchers identified the virulent C. difficile strain, NAP1/027, in 67 percent of hospital-acquired CDAD cases and in 37 percentof community-acquired cases seen in Sherbrooke. In addition, they compared toxin A and B production in NAP1/027 with other contemporary non-epidemic isolates from various locations. They found that NAP1/027 could produce 16 times more toxin A and 23 times more toxin B than control strains. The study also shows that NAP1/027 carries a deletion in a gene (tcdC) involved in the control of toxin production. Warny states, “In the UK, where the number of reported cases of C difficile-associated disease doubled over three years, NAP1/027 is the cause of ongoing outbreaks in at least three hospitals where a high case-fatality ratio has been noted … In the Netherlands, NAP1/027 was identified in two severe outbreaks also associated with fatalities . . . Clinicians need to be vigilant in the prevention, diagnosis and treatment of this disorder.”

Symposium On Clostridium difficile Highlights Difficulties in Containment and Increasing Severity of Disease

Link: Symposium

"Certainly we are seeing a dramatic change in the incidence and severity of CDAD, in our institution and throughout the country, predominantly associated with the emergence of the Toxinotype III strain of Clostridium difficile," commented Dr. Muto. "However, what concerns us the most is difficulty in controlling the rates of nosocomial C. difficile infection. Reduction of HACDI and adverse events associated with infection requires ongoing and significant efforts on multiple fronts. It is essential that institutions attempting to control this infection assure that there is a high level of compliance with these control procedures throughout the institution." In addition to the presentation by Dr. Muto, three additional presentations were given by opinion leaders during the symposium. L. Clifford McDonald, M.D., a medical epidemiologist with the U.S. Centers for Disease Control and Prevention (CDC), provided a general overview of the worsening state of C. difficile disease in the U.S. in a presentation entitled The Changing Epidemiology of Clostridium difficile and Identification of Toxin Variant Strains. Ciaran Kelly, M.D., the associate professor of medicine at the Harvard Medical School, Beth Israel Deaconess Medical Center, outlined the current difficulties in supporting and treating patients with CDAD, in a presentation entitled Clostridium difficile: Treatment Difficulties. Finally, Jacques Pepin, M.D., M.Sc., professor of microbiology and infectious diseases at the University of Sherbrooke in Quebec, discussed his institution's experience in addressing poor patient outcomes and identifying risk factors for severe disease in a presentation entitled C. difficile-associated Disease: Frequency of Poor Outcomes, Risk Factors, Interventions.

C Diff supertoxin rare?

Link: Telegraph

A Department of Health spokesman said: "The large majority of cases of CD diarrhoea make a full recovery. However, some patients may have a more severe course that in a small percentage of cases can be life-threatening. "In order to establish the scale of the problem, CD-associated diarrhoea was added to the mandatory surveillance system for healthcare-associated infection last year and the first results will be published later this year. "The HPA has received some reports of this new strain and is keeping a watching brief on this but the available information indicates that this new strain is rare in the UK. "New toxin-producing strains of CD have occurred before and are not a new phenomenon."

C Difficile could arise in the community

Link: Britain, UK news from The Times and The Sunday Times - Times Online.

A spokeswoman for the agency said that tests now going on would determine if the Stoke Mandeville strain was the same. If so, there are dangers outside hospitals as well as inside them. In the US and Canada, some patients have caught C. diff without setting foot in a hospital, suggesting that it may have reached the community.  Nevertheless, the trend is sharply upwards, with cases doubling since 2000. The figures show that in total 934 people died after contracting the C. diff bug in 2003 — similar to the number of people who died from the MRSA superbug in the same year. Supertoxin strains of C. diff have emerged in the past, only to disappear, the agency said.

New C Difficile strain 20 times more toxic

Link: KRT Wire

Although such cases have been considered rare, federal health investigators are beginning to wonder whether a newer, nastier strain of C. diff - like the one causing an increasing number of deaths in Canada - is striking younger targets who may not have been exposed to antibiotics, hospitals or nursing homes. "We are curious if the profile of patients who get C. difficile may be changing," said Dr. L. Clifford McDonald, a C. diff expert at the U.S. Centers for Disease Control and Prevention. "We were wondering whether this new strain might be part of this. We don't know yet. "This is something we're actively looking into." Tracking the disease is difficult in the United States. C. diff is not classified as a reportable disease, meaning public health officials are not notified of cases and do not gather statistics on the disease, even in those cases ending in death. In April, the Society for Healthcare Epidemiology of America offered perspective on the problem when it released a survey of 201 infectious disease experts. Nearly two in five (38 percent) reported seeing an increase in the number and severity of C. diff cases. Of the 3,292 patients referred to in the survey, 181 (5.5 percent) required removal of the colon, and 198 (6 percent) died. The new strain, which carries 20 times the amount of toxin of previous C. diff strains - has been found in Ohio, Pennsylvania, Connecticut, Florida, Georgia, Illinois, Maine, New Jersey and Oregon. Doctors in Akron noticed the change in C. diff late last year. "Patients are often sicker than they used to be," said Dr. Gary Bollin, chief of infectious disease at Akron General Medical Center. "Rather than just diarrhea, we're seeing high fevers and high white blood cell counts. They tend not to respond as quickly to antibiotics as they did in the past. They often require second- and third-line treatment and require more surgical intervention, something that was unusual in the past."