Almost half a million Americans were infected with the bacteria Clostridium difficile in 2011, and 29,000 died within a month of diagnosis, U.S. health officials report.
82. It is those who believe
(in the Oneness of Allah and worship none but Him Alone) and confuse not their
belief with Zulm (wrong i.e. by worshipping others
besides Allah), for them (only) there is security and they are the guided.
83. And that was Our Proof
which We gave Ibrahim (Abraham) against his people. We raise whom We will
in degrees. Certainly your Lord is All-Wise, All-Knowing.
84. And We bestowed upon him
Ishaque (Isaac) and Ya'qub (Jacob), each of them We guided, and before him, We
guided Nuh (Noah), and among his progeny Dawud (David), Sulaiman (Solomon),
Ayub (Job), Yusuf (Joseph), Musa (Moses), and Harun (Aaron). Thus do We
reward the good-doers.
85. And Zakariya
(Zachariya), and Yahya (John) and 'Iesa (Jesus) and Iliyas (Elias), each one of
them was of the righteous.
86. And Isma'il (Ishmael)
and Al-Yas'a (Elisha), and Yunus (Jonah) and Lout (Lot), and each one of them
We preferred above the 'Alamin (mankind and jinns) (of their
times).
87. And also some of their
fathers and their progeny and their brethren, We chose them, and We guided them
to a Straight Path.
88. This is the Guidance of
Allah with which He guides whomsoever He will of His slaves. But if they
had joined in worship others with Allah, all that they used to do would have
been of no benefit to them. 6. Surah Al-An'am (The Cattle)
"Infections with C. difficile have become increasingly common over the last few decades, and are seen in patients in health-care facilities as well as people in their communities," Dr. Michael Bell said at a U.S. Centers for Disease Control and Prevention press conference Wednesday.
C. difficile, which causes inflammation of the colon and deadly diarrhea, is often linked to antibiotic use, said Bell, deputy director of healthcare quality promotion at the CDC's National Center for Emerging and Zoonotic Infectious Diseases.
Antibiotics can destroy the natural bacterial balance in the colon, allowing C. difficile to take over, he explained.
These infections can be prevented by controlling use of antibiotics, and making sure health-care facilities use infection-control procedures when treating patients infected with C. difficile, Bell said. Such measures have resulted in a 10 percent drop in C. difficile infections since 2011, he added.
"If we can improve antibiotic prescribing, we expect to see rates of C. difficileinfection improve dramatically," Bell said. This means taking antibiotics only when necessary and for as long as necessary, he explained.
Treatment of C. difficile involves antibiotics. However, even when the infection is cured, it is difficult to restore the colon's normal bacteria, which enables C. difficile to recur, Bell explained.
"One in five patients has at least one relapse that requires treatment," he said.
Although anyone can get C. difficile, the elderly are especially vulnerable.
"About 55 percent of health care-associated C. difficile infections and 80 percent of the deaths that occur because of it happen in people 65 years of age and older," Bell said.
- People with mild cognitive impairment may be more ...
Moreover, he added, "one out of nine patients over 65 years old with C. difficile infection dies within 30 days of diagnosis."
The report was published Feb. 26 in the New England Journal of Medicine.
Severe C. difficile infection can damage the colon, requiring surgery, Bell added.
In addition, C. difficile spreads easily. "It forms hard spores that can contaminate the environment," he said. These spores are not killed by antibacterial cleansers or hand sanitizers.
Bell said the best way to prevent transmission is to wash away the spores with soap and water, and for health-care workers treating infected patients to wear gloves.
For the report, researchers collected data on C. difficile infections in 10 areas of the United States in 2011. They wanted to know how many infections were related to health-care facilities, such as hospitals and nursing homes, and how many were contracted in the community at large.
Two-thirds of C. difficile infections occurred in hospitals and nursing homes, the investigators found. However, 150,000 infections were community-associated, meaning they happened among those who had not been inpatients in a health-care facility.
"About 80 percent of patients with community-associated C. difficile infection did have contact with health-care settings, like a doctor's office or a dental clinic, and most of those patients were also given antibiotics," Bell said.
The researchers estimated that there were 453,000 C. difficile infections in the United States that year. They calculated that women, whites and those aged 65 and older were most likely to be infected.
Moreover, the study authors estimated that 83,000 people experienced a first recurrence of C. difficile infection, and that 29,300 people died from the bacteria in 2011.
Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center in New York City, is concerned that C. difficile infections are increasing in the general community.
"The overuse of antibiotics and the improper use of sanitation in hospitals is causing these infections to move into the community," he said. "And that's predictable."
Siegel agreed that careful antibiotic prescribing and better infection control in health-care facilities are needed to curb infections and deaths from C. difficile.
Clostridium difficile (C. difficile) is a bacterium that’s found in people’s intestines. It can be found in healthy people, where it causes no symptoms (up to 3% of adults and 66% of babies).
C. difficile causes disease when the normal bacteria in the gut are disadvantaged, usually by someone taking antibiotics. This allows C. difficileto grow to unusually high levels. It also allows the toxin that some strains ofC. difficile produce, to reach levels where it attacks the intestines and causes mild to severe diarrhoea.
C. difficile can lead to more serious infections of the intestines with severe inflammation of the bowel (pseudomembranous colitis). C. difficile is the biggest cause of infectious diarrhoea in hospitalised patients.
You can become infected with C. difficile if you ingest the bacterium (through contact with a contaminated environment or person). People who become infected with C. difficile are usually those who’ve taken antibiotics, particularly the elderly and people whose immune systems are compromised.
Clostridium difficile (or C. difficile, C. diff) colitis is a common infection of the colon that is typically associated with the use of antibiotics. It is, therefore, also called antibiotic-associated colitis. Another common name for this condition is pseudomembranous colitis.
Clostridium is a family of bacteria containing several members. Some of the other well known bacteria in this group include Clostridium botulinum and Clostridium tetani, which are the causes of botulism and tetanus, respectively.
There are typically two forms of Clostridium difficile; one is the inactive or non-infectious form, called the spore, and the other is the active and infectious form. The spore form can survive in the environment for a long time, whereas the active form cannot.
Clostridium difficile colonize the intestinal tract by the oral route (mouth). This disease typically follows the disruption of the balance of normal colonic bacteria (normal flora), which is usually due to the use of antibiotics. Although C. diff spores may reside in the active form in the colon of some individuals (carrier state), they can also be ingested in this form (fecal-oral transmission).
After being shed in the stool, C. diff may be found residing in many places, especially in hospitals, nursing homes, and other health care facilities.
The common locations of the C. diff include:
- furniture,
- bathroom floors,
- stethoscopes,
- bedpans,
- telephones,
- fingernails,
- floors,
- diaper pails,
- jewelry (rings),
- infant's rooms,
- toilet seats, and
- other objects commonly used by patients and health care professionals.
During the last 10 years, C. difficile infections have been observed to be more frequent, severe, and resistant to standard therapy. This is linked to the emergence of new strains of C. difficile and continued increase use of antibiotics. Large out breaks of C. difficile infections have been observed throughout North America and Europe. Not only are the incidence of these infections increasing in the hospital setting but they are also occurring in the community setting (community acquired infections ).
In the colon, the C. diff spores are present in the inactive form. There are numerous different bacteria that typically reside in the colon and are a part of the normal flora of the colon. These bacteria prevent the activation of the C. diff spores into the active bacterial form.
However, when antibiotics are administered for the treatment of an infection, they may kill some of the normal colonic bacteria. This process disrupts the normal balance of gut bacteria and allows Clostridium difficile to become activated and infectious.
When C. diff becomes activated, it produces two different toxins (chemicals), toxin A and toxin B. These toxins may cause inflammation of the inner lining of the colon, resulting in pooling of white blood cells in the colon. If the inflammation is severe, it can result in destruction of the normal cells that line the inside of the colon. When these cells are destroyed they shed, and a large number of white blood cells may appear as small whitish membranes when visualized by colonoscopy(camera placed inside the colon). These membranes are referred to as pseudomembranes because they are not real membranes, thus the name pseudomembranous colitis.
The inflammatory process may result in diarrhea, abdominal pain, fever, and other signs of infection.
It is important to note that not all antibiotics cause C. difficile colitis, and not everyone receiving antibiotics will develop this infection. It is also worth mentioning that diarrhea may occur due to antibiotics for other reasons and that not all antibiotic-associated diarrheas mean that the individual has C. difficile colitis. Many antibiotics can cause diarrhea as a side effect through unknown mechanisms.
Although any antibiotic is a potential risk factor for C. diff infection, the ones most commonly recognized are:
- clindamycin (for example, Cleocin),
- fluoroquinolones (for example, levofloxacin [Levaquin], ciprofloxacin [Cipro, Cirpo XR, Proquin XR]),
- penicillins, and
- cephalosporins.
Other risk factors for C. diff infection include:
- hospitalization,
- age greater than 65 years,
- the presence of chronic medical conditions, and
- severe illness.
Another possible additional risk factor is the suppression of gastric acid.
The symptoms of C. difficile colitis range from mild to severe. Watery diarrhea is the main symptom regardless of the severity of the infection, although it may not be present in every patient.
Some patients are carriers of the organism and do not develop an active infection. These individuals may shed the organism and cause environmental contamination.
Generally, mild C. diff infection (in addition to diarrhea) may result in:
- abdominal pain and cramping,
- bloating,
- nausea,
- vomiting,
- fatigue, and
- fever.
The diarrhea may occur up to 10 to 15 times daily. More severe infections may cause severe and profuse diarrhea, severe abdominal pain, and high fever. Toxic megacolon, which indicates a massively enlarged and distended colon, is a manifestation of severe disease. Severe cases may also be associated with generalized infection (sepsis) resulting in instability of blood pressure and heart rate, as well as disruption of the functions of other body organs (septic shock).
It is not clear why different individuals have different reactions to C. difficileinfections.
Similar to other illnesses, a thorough medical examination by the doctor is necessary in evaluating for C. difficile colitis. A careful review of all medications, especially antibiotics, and recent hospitalization or nursing home admissions should be carried out.
Laboratory tests include blood work including a basic chemistry panel and complete blood count (CBC). An elevated white blood cell count (WBC), or leukocytosis, is very common in C. diff infection. The WBC is typically elevated in any type of bacterial infection, but in C. diffinfection it is markedly elevated, often much higher than with other infections.
There are two ways to detect the presence ofC. difficile.
- Testing for the toxin produced by the organism (toxin assays)
- Detecting the actual organism. Although the detection of the organism in stool cultures is the most sensitive way of diagnosing C. difficile, it takes a few days to make this determination, which makes this a less useful method.
Stool samples should be collected and analyzed. The presence of C. diff toxins in the stool is diagnostic of the infection, and the results of stool analysis are generally available within a day or so. The actual detection of Clostridium difficilebacterium by stool cultures may also be done. This, however, may take a few days, which may delay the diagnosis and treatment. C. diff culture may be positive in a carrier; however, the strain of the organism may be one that does not cause infection.
Other tests used to diagnose C. difficile colitis are a CT scan of the abdomen, which may show thickening of the wall of the colon, signifying inflammation. This finding is not specific as it may be present in other inflammatory diseases of the colon; however, it may add further evidence for C. difficile colitis in the proper clinical setting.
Sigmoidoscopy and colonoscopy are other procedures which may be useful in the evaluation of C. difficile colitis. These procedures involve inserting an endoscope (a tube), which has a camera and a light source at the tip, into the colon from the rectum. Visualization of pseudomembranes suggests C. diff infection. These tests are not always necessary to diagnose the infection, but they may have a role in cases where the diagnosis is in doubt due to non-diagnostic stool tests, unresponsiveness to appropriate treatment, or unusual presentation of the disease with little or no diarrhea and fever.
Examination of the stool for white blood cells (fecal leukocytes) is also an easy and helpful way to indicate possible C. diff infection.
If the doctor suspects that C. difficile colitis is causing the diarrhea, the offending antibiotic will be stopped. Treatment of C. diffrequires the use of antibiotics which are different from the ones that cause diarrhea. The antibiotics used to treat C. diff colitis requires include vancomycin (Vancocin) andmetronidazole (Flagyl), with newer antibiotics being studied. It is ironic that the treatment of the C. diff infection caused by antibiotics is with different antibiotics.
In cases of severe illness and dehydration, the doctor may recommend admission to the hospital in order to start aggressive treatment with intravenous fluid and antibiotics, as well as for close monitoring for any metabolic disturbances and evidence of severe inflammation and distention of the colon. In severe cases, oral intake is stopped in order to give rest to the colon and prevent further stimulation of the bowel. Admission to the intensive care unit (ICU) may sometimes be necessary if there is evidence of unstable blood pressure and disturbance of other body functions.
It may take several days for the diarrhea to stop, despite prompt discontinuation of the offending antibiotics and aggressive medical care.
It is important to note that contrary to other causes of diarrhea, anti-diarrheal medications are discouraged in C. difficile colitis. This is because these drugs may slow down the removal of the bacteria and its toxins from the colon and, thus, prolong the infection.
In rare cases of severe infections with megacolon, impending colon perforation, severe generalized infection (sepsis) that may be life-threatening, surgery to remove the colon may be advised.
Because individuals with C. difficile colitis are infectious, it is important to eliminate the spread of infection to others. This is best done by careful hand washing by both the infected person and others who come into contact with the individual. Washing hands with soap and water is the recommended approach. The use of alcohol-based disinfecting agents is not recommended since they are as not effective against C. diff spores.
Besides hand washing by everyone in contact with the patient, thorough cleaning of the environment is an important aspect of the prevention of the spread of C. difficile. Hypochlorite based solutions are more effective than other solutions in eliminating C. difficile.
In health care facilities, patients with C. diffinfection are usually placed in isolation in order to prevent transmission to other patients. The isolation is discontinued after stool tests show no further evidence of infection (no toxins), or if the patient is doing well enough to return home. Isolation at home is usually neither necessary nor practical.
Heartburn drugs such as Prilosec and Nexium may disrupt the makeup of bacteria in the digestive system, potentially boosting the risk of infections and other problems, a small new study suggests.
The research doesn't confirm that these changes make it more likely users will become ill, and study authors aren't recommending that anyone stop taking the so-called proton pump inhibitors.
However, these antacids "should be used at the lowest dose that provides adequate relief of symptoms, and attempts to discontinue their use should be considered periodically," said study co-author Dr. John DiBaise, professor of medicine at the Mayo Clinic in Scottsdale, Ariz.
According to Harvard Medical School, billions of dollars are spent annually on antacid drugs in an attempt to combat heartburn, ulcers and gastroesophageal reflux disease, also known as GERD. Old standbys such as Maalox and Mylanta have been supplanted by more effective, more expensive drugs, including proton pump inhibitors. These include Prevacid (lansoprazole) and Protonix (pantoprazole) in addition to Prilosec (omeprazole) and Nexium (esomeprazole).
"Despite years of safe and effective use, in recent years there have been an increasing number of reports suggesting potentially harmful effects and harmful associations with their use," DiBaise said.
Long-term use of proton pump inhibitors has been linked to infection with a germ calledClostridium difficile, which causes severe diarrhea, he said. Researchers have also connected the medications to vitamin deficiencies, bone fractures and pneumonia, among other conditions.
In the new study, researchers sought to understand what happens to the trillions of germs in the digestive system when people take omeprazole, the generic name for the drug best known as Prilosec.
Ten participants, aged 18 to 57, took 20 or 40 milligrams of the drug a day for 28 days. Researchers analyzed the study participants' stool samples to understand the germs in their guts.
"These microbes have evolved with us to participate in our normal development and metabolism, and perform certain functions that we would not be able to accomplish without their help," DiBaise said. Many scientists believe that people's risk of disease goes up when their normal germ makeup changes, he said.
The researchers found evidence that the medications disrupted the balance of bacteria in the digestive systems of the participants, and the changes lasted for at least a month after they discontinued the drug. It didn't seem to matter whether they took the higher or lower dose, DiBaise said.
DiBaise cautioned that the study doesn't prove that the drug causes users to become more vulnerable to C. difficile infections. However, it shows that the drug "creates a situation in the gut microbial environment that may increase an individual's susceptibility," he said.
The researchers suggest additional research is needed with a larger group of study participants.
What should users do for now? According to DiBaise, proton pump inhibitors are "the most effective medications to treat gastroesophageal reflux disease." If patients don't have the most severe symptoms, he said, other types of heartburn drugs might help. Also recommended: eating smaller portions, losing weight, not lying down for two hours after eating, and avoiding alcohol, cigarettes and "trigger" foods.
Dr. David Johnson, chief of gastroenterology at Eastern Virginia Medical School, said patients shouldn't become alarmed about "the safest class of therapy I've used in the 34 years being a doctor."
The new research won't stop him from prescribing the drugs, Johnson said, adding he's "hesitant to make too much out of this." Even so, "the key message is that patients should talk to their care provider and discuss the need for these medications and justify their continued use."
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