MRSA Infection

Antacid tablets provoking C Diff in pregnant women?

Link: globeandmail.com

    The president of the association, Dr. Martin Blaser, suggested the cases might be related to a high use during pregnancy of a type of antacid medication that some researchers believe may make people more susceptible to C. difficile infection — proton pump inhibitors. (Nexium is a member of this class of drugs.) The link between PPIs, as they are called, and C. difficile was first proposed by McGill University researcher Dr. Sandra Dial and is still considered unproven. Some outside research has supported Dial's findings but others have not. Blaser, though, said the way the drugs work in the body adds weight to the argument they could make someone more vulnerable to C. difficile, a bacteria which can grow out of control in the human gut if the normal bacterial balance is thrown off by use of antibiotics or some other factor. “It is biologically plausible, because PPIs change human micro-ecology. And as this problem emerges, unless we can get a handle on it, physicians are going to have to recognize that this is an additional risk of being on PPIs,” said Blaser, a microbiologist at New York University School of Medicine. O'Donnell and several colleagues reported that in the first six months of this year, they treated six previously healthy women with C. difficile disease. Three were pregnant, one had just given birth and two others had recently undergone hysterectomies. They didn't see a single such case in 2005, she noted. The women were all believed to have become infected outside a hospital setting — an emerging trend with this troubling disease. Reports of C. difficile in pregnant women have popped up from other areas as well. A study of community-acquired C. difficile cases in North Carolina, for instance, identified two women who had the disease. And the U.S. Centers for Disease Control reported late last year on a series of community C. difficile cases that included 10 women who were pregnant or had recently delivered in New Hampshire, New Jersey, Pennsylvania and Ohio. One women died from complications of the disease.

Health Canada says it will monitor emerging findings on C. difficile in meat

Link: Health Canada

     "I think it's of urgent public health urgency to follow up on this and to determine whether meats are an issue - and then to determine exactly what we can do to reduce risk if it were," Dr. Clifford McDonald said. McDonald and other experts do not know what to make of the findings. C. difficile spores - which are believed to be widely dispersed in soil and water - may have always been present in some meats and may cause no threat to human health, they say. Alternatively, the findings may represent a change in the pattern of dissemination of C. difficile spores that could help to explain an apparent upswing of C. difficile cases in people who haven't been recently hospitalized. Traditionally it has been thought C. difficile occurred almost exclusively in elderly people in hospital who had been on antibiotics. The drugs destroy the normal balance of bacteria in the guts, allowing C. difficile to take root and flourish.

C difficile found in meats

Link: Fort Frances Times Online

     C. difficile bacteria have been found in a variety of ground and processed meats bought from grocery stores in Canada and the United States—an unexpected discovery some experts say may be linked to recent baffling changes in the pattern of the disease.     Some of the U.S. meats contained the hypervirulent C. difficile strain responsible for severe outbreaks in hospitals in Quebec, Britain, and parts of the U.S. over the past few years, The Canadian Press has learned.     In Quebec alone, the so-called epidemic strain is blamed for roughly 2,000 deaths in 2003 and 2004.     Though still largely a plague of the elderly in hospitals, C. difficile-associated disease has undergone unexplained shifts of late—some deaths in younger people, more infections outside the hospital.     At the same time, there has been a rapid spread of the epidemic strain across North America and to Europe.     Experts keen to figure out what’s going on with this bug say the meat finding may provide a clue and must be explored.

Proton pump inhibitor use and risk of community-acquired Clostridium difficile-

Link: Canadian Medical Association Journal.

    The association between the use of proton pump inhibitors and the risk of Clostridium difficile-associated disease (CDAD) is controversial. In this study we re-examined a previously reported association between the use of proton pump inhibitors and the development of community-acquired CDAD, this time using an alternative case definition of the disease. Methods: We performed a case–control study of community-acquired CDAD using a United Kingdom clinical research database. Patients receiving oral vancomycin therapy were identified as having CDAD, the only indication for this drug. Each case subject was matched with up to 10 control subjects. Neither the cases nor the controls had been admitted to hospital in the year before the date of the vancomycin prescription (index date). Conditional logistic regression analysis was used to adjust for key covariates. Results: We identified 317 cases of community-acquired CDAD treated with oral vancomycin therapy and 3167 matched control subjects. Exposure to a proton pump inhibitor in the 90 days before the index date was associated with an increased risk of CDAD (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.3–5.2). Antibiotic exposure in the 90 days before the index date was also a significant risk factor for community-acquired CDAD (OR 8.2, 95% CI 6.1– 11.0), even though 45% of the case subjects had not received a prescription for an antibiotic during that period. Certain comorbidities, in particular renal failure, inflammatory bowel disease and malignant disease, as well as prior methicillin-resistant Staphylococcus aureus infection, were also associated with an increased risk. Interpretation: Proton pump inhibitor use was associated with an increased risk of community-acquired CDAD, when cases were defined by receipt of prescription for oral vancomycin therapy. Prior antibiotic exposure was also a significant risk factor, but a significant proportion of the patients with community-acquired CDAD had no such exposure.

Researchers Identify Antibiotics Most Likely to Cause Clostridium Difficile

Link: News -  ICAAC.

    Patients are more likely to acquire an infection of Clostridium difficile if they take any 1 of 4 antibiotics -- imipenem, ceftazidine, clindamycin, or moxifloxacin -- according to research presented here at the 46th annual meeting of the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC). C. difficile infection is the most common cause of hospital-acquired antibiotic-associated diarrhea. Patients who take tetracycline are less likely to get the infection, said principal investigator Roger Baxter, MD, infectious disease specialist, Kaiser Permanente Medical Center, Oakland, California. "Patients who take imipenem are more than 3 times as likely to acquire C. difficile," he said in a presentation on September 27th.

Community-acquired C Difficile - antacids a factor

Link: Canadian Medical Association Journal.

    Background: The association between the use of proton pump inhibitors and the risk of Clostridium difficile-associated disease (CDAD) is controversial. In this study we re-examined a previously reported association between the use of proton pump inhibitors and the development of community-acquired CDAD, this time using an alternative case definition of the disease. Methods: We performed a case–control study of community-acquired CDAD using a United Kingdom clinical research database. Patients receiving oral vancomycin therapy were identified as having CDAD, the only indication for this drug. Each case subject was matched with up to 10 control subjects. Neither the cases nor the controls had been admitted to hospital in the year before the date of the vancomycin prescription (index date). Conditional logistic regression analysis was used to adjust for key covariates. Results: We identified 317 cases of community-acquired CDAD treated with oral vancomycin therapy and 3167 matched control subjects. Exposure to a proton pump inhibitor in the 90 days before the index date was associated with an increased risk of CDAD (odds ratio [OR] 3.5, 95% confidence interval [CI] 2.3–5.2). Antibiotic exposure in the 90 days before the index date was also a significant risk factor for community-acquired CDAD (OR 8.2, 95% CI 6.1– 11.0), even though 45% of the case subjects had not received a prescription for an antibiotic during that period. Certain comorbidities, in particular renal failure, inflammatory bowel disease and malignant disease, as well as prior methicillin-resistant Staphylococcus aureus infection, were also associated with an increased risk. Interpretation: Proton pump inhibitor use was associated with an increased risk of community-acquired CDAD, when cases were defined by receipt of prescription for oral vancomycin therapy. Prior antibiotic exposure was also a significant risk factor, but a significant proportion of the patients with community-acquired CDAD had no such exposure.

Antacids raise risk of C. difficile

Link: McGill researchers

     Widely prescribed antacid drugs appear to be linked to a higher rate of C. difficile cases in people who have acquired the nasty bacterium outside of hospitals, a team of Montreal researchers reported Monday in the Canadian Medical Association Journal. Using data collected on the patients of family doctors in Britain, the researchers showed that non-hospitalized people who took drugs known as proton pump inhibitors were three and a half times more likely to develop Clostridium difficile than people who didn't take the popular drugs. Lead author Dr. Sandra Dial acknowledged the possible link between PPIs - as the drugs are called - and C. difficile is controversial. Until recently it was widely assumed that C. difficile-associated diarrhea was largely a disease one caught in hospitals and was almost always linked to antibiotic use. But Dial and others are now exploring the notion that by focusing so closely on the role antibiotics play in triggering the disease, the medical community may have missed the full picture.

Abortion Pill makes women more infection prone

Link: New York Times.

     The government has already scheduled a scientific conference on May 11 at the Centers for Disease Control and Prevention to discuss Clostridium sordellii and a related bacteria, Clostridium difficile, that has caused outbreaks of diarrhea and colitis in hospitals and nursing homes across the nation. Both bacteria generally live in the soil and human intestinal tracts. Both thrive in environments with limited oxygen. When these bacteria infect the bloodstream, they can produce a toxin that causes something akin to toxic shock syndrome. The Food and Drug Administration has already added strong warnings to the label of RU-486, or Mifeprex. But officials say that they have no idea whether Mifeprex makes patients vulnerable to infection from C. sordellii. Mifeprex has been used in more than 560,000 medical abortions in the United States since its approval in September 2000, and it has been used in more than 1.5 million abortions in Europe. The risks of death from infection after using the pill are similar to the risks after surgical abortions or childbirth, officials said. Monty Patterson, whose 18-year-old daughter Holly died on Sept. 17, 2003, from a C. sordellii infection after getting a medical abortion, has long argued that Mifeprex predisposes women to such infections by suppressing their immune systems. He wants the drug withdrawn. "How many women have to die needlessly before this drug is removed from the market?" Mr. Patterson said.

U.S. Investigates C Diff type illness among morning after pill users

Link: U.S. Investigates Four Deaths Linked to Abortifacient RU-486.

     WASHINGTON, D.C., United States, February 13, 2006 (LifeSiteNews.com) – The U.S. government has called for a special scientific investigation into the deaths of four California women, who died from a rare bacterial infection after taking the dangerous abortion drug RU-486. Up to 20 scientists, who have studied the deadly bacteria Clostridium sordellii that caused the deaths, will look into the connection between the effects of the abortion pill and the bacteria’s presence in the women’s blood stream. The abortion pill has been a source of intense controversy since it first appeared in France over 20 years ago. Opponents say it was never properly tested for safety although it has received extensive support from abortion advocates. Ten women have died after taking the pill, including the four California deaths. There have been multiple cases of severe side effects, including haemorrage, with over 600 cases reported in the U.S. alone. Questions around the safety of the abortion pill RU-486 have caused such intensive controversy in the U.S. that security for the May 11th conference will be unusually tight, an FDA official told the New York Times. Backlash from activists for the abortion pill has led to threats against officials for speaking out against the drug. The conference, which will be held at the Centers for Disease Control and Prevention in Atlanta, will also look at a closely related bacteria, C-difficile, which has caused severe intestinal illness among residents in hospitals and nursing homes. The National Institutes of Health will also participate.

Use Of Gastric Acid-suppressive Agents Linked With Increased Risk For Diarrhea Infection

Link: Use Of Gastric

Recent press about hospital C Diff has not highlighted the facts below. They point to over a possible 12,000 community acquirred cases of C Diff per year in the UK. Its not clear how many of these are of the virulent strain now being found in hospitals.

A British study identified C difficile as the third most common cause of infectious diarrhea in patients aged 75 years and older seen by general practitioners. A French study performed in outpatients to whom antibiotics were prescribed reported an incidence of C difficile-associated disease (CDAD) of 1.5 percent and estimated that up to 920,000 outpatients nationwide could potentially develop toxinogenic CDAD yearly. Recent data suggest that both the rates and severity of nosocomial CDAD are increasing. While the rates of CDAD in the community are much lower than in the hospital setting, the absolute number of cases in the community could be significant.

Sandra Dial, M.D., M.Sc., and colleagues from McGill University, Montreal, conducted a study to determine whether the use of gastric acid-suppressant drugs is associated with the risk of community-acquired CDAD. This study consisted of two population-based case-control studies using the United Kingdom General Practice Research Database (GPRD). In the first study, the researchers identified all 1,672 cases of C difficile recorded between 1994 and 2004 among all patients registered for at least 2 years in each practice.

The researchers found that of these 1,672 patients, 1,233 (74 percent) had not been hospitalized in the year prior to diagnosis and were considered community-acquired. There has been a significant increase in the rate of C difficile cases diagnosed in the community from less than 1 per 100,000 persons in 1994 to 22 per 100,000 in 2004.

Heart burn medication a risk factor for community-acquired C. difficile

Link: Heart burn

  Researchers have discovered that drugs, such as heart burn medications, which reduce gastric acidity, are potential risk factors for Clostridium difficile infection outside of hospitals. The new research to be published in the Journal of the American Medical Association (JAMA) tomorrow focuses on community-acquired C. difficile, and is a follow-up to previous work by the same group that demonstrated an increased risk from these medications in hospital settings.

"We believe drugs that reduce gastric acidity provide a more hospitable environment within which C. difficile bacteria can colonize," says MUHC researcher and lead author of the new study Dr. Sandra Dial. Numerous studies worldwide have documented increases in hospital C. difficile associated disease, but this study is the first to suggest this trend is mirrored in the general community. Dr. Sandra Dial is Attending Staff in the Department of Critical Care at both the MUHC and Jewish General Hospital (JGH) and an Assistant Professor of Medicine at McGill University.

Using data from the United Kingdom General Practice Research Database (GPRD), researchers traced variation in community C. difficile associated disease over a 10-year period. "In 1994 there was less than one C. difficile case per 100,000 people in the database," says Dr. Dial. "By 2004, this number had increased exponentially to 22 cases to per 100,000." It is important to note however, that community rates are still much lower than hospitals overall.

A surprising discovery in the study was that over 70% of the patients who developed C. difficile associated disease had not been admitted to hospital in the past year, and that less than 50% had taken antibiotics in the three months prior to developing disease. "This is noteworthy because unlike previous beliefs it is now evident that C. difficile disease has left the hospital setting to reach the community and that antibiotics are not the only culprit," says senior author of the study Dr. Samy Suissa, Director of the Division of Clinical Epidemiology at the MUHC and James McGill Professor of Epidemiology, Biostatistics and Medicine at McGill University.

This discovery follows on the heels of an announcement last week that researchers from the MUHC and JGH have sequenced the Quebec strain of C. difficile. McGill and its affiliated hospitals will continue to take a leading role in C. difficile research in order to improve treatments and prevention techniques, as well as develop more rapid diagnosis for an infection that has become a serious health concern, not just in Quebec but around the world.

Ulcer drugs a C Diff factor?

Link: Bloomberg.com: Canada.

Millions of people worldwide take the drugs, called proton- pump inhibitors, to treat a condition known as gastroesophageal reflux disease, or GERD, which occurs when stomach acid flows into the esophagus, causing heartburn and ulcers. The drugs may be raising patients' risk of a severe bacterial infection that has increased quickly in frequency, Dial said today.

``These drugs may make it easier to become infected if you've already been exposed,'' she said in a presentation at the Interscience Conference on Antimicrobial Agents and Chemotherapy, a major infectious disease science meeting.

Other stomach acid treatments also showed links to the infection. People with C. difficile were twice as likely to take so-called H2 receptor antagonists, which include GlaxoSmithKline Plc's Tagamet, than healthy people, the study said.

Treatment for GERD is a $12.5 billion U.S. market dominated by Nexium, Prevacid, and Wyeth's Protonix. Nexium is AstraZeneca's top-seller, bringing in 2004 revenue of $3.8 billion for the U.K.'s No. 2 drugmaker.

Antibiotics are killing the old

Link: News.

Sandra's elderly mother went into hospital with a cough, but was dead within four months after contracting Clostridium difficile. She had experienced severe diarrhoea but it was only when Sandra picked up her mother Maria's prescription that she realised that she had caught the lethal bug that is infecting patients across the NHS. Sandra looked up the antibiotics on the internet and found that they were used to treat C. difficile, which she had not heard of before. "I was not told what the illness was and I had never heard of the antibiotics" she recalled. "So I looked them up and the first word that came up was C. difficile. I did not know what it was - but the more I saw, the less I liked it. "I found a support group in America set up by a husband and wife and it had taken the wife a year to get better."