C-Diff and antibiotics | Arthritis Information

This might be the article that birdgirl was referencing...

Gut superbug sickening thousands a year
Cases of drug-resistant germ Clostridium difficile becoming more severe

The number of people hospitalized with a dangerous intestinal superbug has been growing by more than 10,000 cases a year, according to a new study.

The germ, resistant to some antibiotics, has become a regular menace in hospitals and nursing homes. The study found it played a role in nearly 300,000 hospitalizations in 2005, more than double the number in 2000.

The infection, Clostridium difficile, is found in the colon and can cause diarrhea and a more serious intestinal condition known as colitis. It is spread by spores in feces. But the spores are difficult to kill with most conventional household cleaners or antibacterial soap.

C-diff, as it's known, has grown resistant to certain antibiotics that work against other colon bacteria. The result: When patients take those antibiotics, competing bacteria die off and C-diff explodes.

This virulent strain of C-diff was rarely seen before 2000.

"The nature of this infection is changing. It's more severe," said Dr. L. Clifford McDonald, a Centers for Disease Control and Prevention expert who was not part of the study.

There are other factors that play into the rise of C-diff cases as well, including a larger of number of patients who are older and sicker. "And there may be some overuse and inappropriate use of antibiotics," said Dr. Marya Zilberberg, a University of Massachusetts researcher and lead author of the study.

The Zilberberg study was based on a sample of more than 36 million annual discharges from non-governmental U.S. hospitals. That data was used to generate the study's national estimates.

http://www.msnbc.msn.com/id/24855738/

or this one

http://www.cnn.com/2008/HEALTH/conditions/05/28/deadly.bacteria/index.htmlLynn492008-05-30 10:14:38I think this part of the link I posted on PPI's said it best -

Antibiotics blamed unfairly

Concern over the increasing incidence and severity of C. difficile hit the scientific community several years ago. In the flurry of research papers that has followed, the nasty and recurrent diarrhea has been largely described as a hospital-based problem, where rampant antibiotic use has made patients vulnerable to the sometimes fatal bacterium.

But Dial and others are suggesting antibiotics alone can't account for the entire increase, particularly in C. difficile infections in people who haven't recently been hospitalized.

"It's almost like they got an unfair head start in the blame game," Dial said.

"They definitely play an important role. But the message we'd maybe like to get out is: if your patient in the community hasn't gotten an antibiotic but they're having diarrhea, and if they're elderly and they're sick and have some of the other things [risks] we've found, consider checking them for C. diff.

"Don't just assume they don't have it because they didn't get an antibiotic."

Finally, aren't you worried at all about being on a immunesuppressor and getting C diff? It's all over PubMed. TNF's don't neutralize apoptosis and people are dropping dead like flies.

Results

In 2000, the incidence of C. difficile colitis in hospitalized patients increased from a baseline of 0.68% to 1.2%, and the incidence of patients with C. difficile colitis in whom life-threatening symptoms developed increased from 1.6% to 3.2%. Forty-four patients required a colectomy and 20 others died directly from C. difficile colitis. Twenty-two percent had a prior history of C. difficile colitis. A recent surgical procedure and immunosuppression were common predisposing conditions. Lung transplant patients were 46 times more likely to have C. difficile colitis and eight times more likely to have severe disease. Abdominal computed tomography scan correctly diagnosed all patients, whereas 12.5% of toxin assays and 10% of endoscopies were falsely negative. Patients undergoing colectomy for C. difficile colitis had an overall death rate of 57%. Significant predictors of death after colectomy were preoperative vasopressor requirements and age.

Or this -

Spectrum of Disease and Prognostic Factors

Although costly and disabling, symptomatic C difficile infection usually presents as mild colitis that is easily controlled with treatment; however, a small subset of patients develops severe, toxic colitis, with dehydration, colonic ischemia, shock, and even death. In a retrospective case-control study of patients with severe C difficile colitis, Rubin et al^[5] found that there was a significant association with advanced age, comorbid conditions (malignancy, chronic obstructive pulmonary disease, and renal insufficiency), and medications (clindamycin, antiperistaltics, and immunosuppressants). Prognostic signs and symptoms in this and other series included mental status decline, peritoneal signs, hypoalbuminemia, radiographic indexes of severity such as colonic intramural gas and leukocytosis.^[4,5] In fact, C difficile infection has been occasionally associated with leukemoid reactions in patients without HIV infection.

Or this -

^{http://www.ingentaconnect.com/content/mksg/tid/2007/00000009/00000004/art00005}

^{Abstract:
Z.F. Gellad, B.D. Alexander, J.K. Liu, B.C. Griffith, A.M. Meyer, J.L. Johnson, A.J. Muir. Severity of Clostridium difficile-associated diarrhea in solid organ transplant patients.
Transpl Infect Dis 2007: 9: 276-280. All rights reserved Abstract:
Clostridium difficile-associated diarrhea (CDAD) has a wide spectrum of disease severity. Studies have implicated immunosuppressants as a risk factor for severe disease. We hypothesized that solid organ transplant (SOT) patients with CDAD would be at greater risk for severe disease because of their profound immunosuppression. Adult SOT patients with CDAD seen at Duke University Medical Center between 1999 and 2003 were compared with a reference group of non-transplant patients with CDAD. The primary outcome was the development of complicated colitis defined as death, intensive care unit admission, or urgent colectomy within 30 days of diagnosis. A secondary outcome was relapse within 60 days. Eighty transplant and 86 non-transplant cases were reviewed. There was no significant difference in the development of complicated colitis (13.8% vs. 7.0%) or relapse rates (6.2% vs. 7.0%) between the 2 groups. In the entire sample, 18.5% of patients receiving corticosteroids unrelated to transplantation relapsed as compared with 4.5% not receiving corticosteroids (risk ratio 4.3, P=0.02). In conclusion, no significant difference was found in severity of CDAD between SOT patients and non-transplant patients. Exposure to corticosteroids was significantly associated with an increased risk of relapse and may warrant a longer treatment course.

Keywords: Clostridium difficile; diarrhea; colitis; solid organ transplantation; recurrence; severity; corticosteroids
Document Type: Research article
DOI: 10.1111/j.1399-3062.2007.00255.x
Affiliations: 1: Department of Medicine, Division of Gastroenterology, 2: Department of Medicine, Division of Infectious Diseases and International Health, 3: Department of Medicine, 4: Comprehensive Cancer Center Biostatistics, Duke University Medical Center, Durham, North Carolina, USA

Do you realize how many of us are on cortosteroids?

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