You might say Jacob Epstein, a lean, healthy, 88-year-old Floridian, died in early May from a broken arm. Following surgery to reset the bone, he was given an antibiotic to prevent postoperative infection, a common hospital practice.
His daughter, Beth Fidanza, recalled that within a week her father developed diarrhea caused by a nasty intestinal bacterium called Clostridium difficile, or C. diff. Another antibiotic seemed to eradicate the disease, but a month later the gut infection recurred, and within days Epstein developed a fatal combination of kidney failure, low blood pressure and gastrointestinal bleeding.
Epstein’s demise was really the result of inappropriate use of antibiotics, which has given rise to a virulent, antibiotic-resistant strain of C. diff., an organism that causes close to 500,000 new cases and 30,000 deaths a year in the United States.
C. diff. is a spore-forming, toxin-producing bacterium that can colonize the large intestine and wreak havoc there, causing frequent watery stools and severe dehydration. The spores are resistant to heat, acid and antibiotics; they can be washed away with soap and water but not the alcohol-based hand sanitizers widely used in health facilities. Thus, poor bathroom hygiene can spread the organism.
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“C. diff. is found in soil and water, even chlorinated water, and is a low-level contaminant in food,” said Dr. Dale Gerding, an infectious diseases specialist at Loyola University Chicago. “Most of us ingest C. diff. every day.”
In most people, the microorganisms that normally reside in the gut protect against C. diff. infection, he said. That is, until antibiotics disrupt the balance of microorganisms. Freed of competition, C. diff spores can reproduce unchecked, and not only in people with compromised immune systems.
Since the early 2000s, hospitals have reported drastic increases in severe C. diff. infections. The predominant virulent strain, NAP1, has a mortality rate three times as high as that associated with the less virulent forms prevalent in decades past.
The good news, Gerding said, is that new treatment approaches are proving capable of preventing recurrences and may be able to prevent an initial infection in the future.
Gerding and his colleagues describe a treatment using a nontoxin-producing strain of C. diff. in patients who initially recovered from an infection. While not a permanent solution, the strain persists in the intestine long enough to allow the normal healthy microbiota to repopulate the gut and greatly reduce the risk of a recurrence.
A more permanent solution now under study involves an injectable antitoxin vaccine. Because it can take months for vaccine protection to take effect, a temporary measure could be used in the interim, Gerding said.
Well-publicized treatments using fecal transplants from healthy individuals are reserved for patients who have experienced multiple recurrences of C. diff. Researchers are trying to isolate the organisms in feces from healthy people that are most effective, with the hope of incorporating them into a capsule that could be taken orally as a treatment or preventive.
At Carolinas HealthCare System University in Charlotte, Dr. Barry Schneider of Carolina Digestive Health Associates has performed fecal transplants for about 100 patients since 2012 as part of a clinical trial. He said the procedure has had a 90 percent success rate. He helped start a similar program at Novant Health Presbyterian Medical Center, where four fecal transplants have been performed in the past year by Drs. Michael Gaspari and Jason Wilson.
Staff writer Karen Garloch contributed.