Hospitals fight a drug-resistant bug that can kill

Frances Dean survived pneumonia and heart surgery. But C. diff. - now that was nasty stuff.

C. diff. - short for a bacterial infection called Clostridium difficile - sapped Dean's strength, knotted her insides, forced her to the emergency room with dehydration, and sent her running to the bathroom up to 20 times a day. Just when she thought she was rid of it, it kept coming back. She was housebound off and on for a total of seven months. And she knew the infection could be fatal.

"My chest is sore (from heart surgery) but at least you know it's going away," the St. Charles widow said. "With C. diff., you don't. It's probably the worst thing I've ever experienced."

A new, deadly strain of C. diff. is lying in wait at hospitals for patients like Dean, 68, who are most vulnerable - older people who are on antibiotics for another illness.

The new super bug is 20 times more toxic than the old strain, and is resistant to treatment, which makes it one of the top infectious disease threats in hospitals today.

The infection rate has recently doubled in both frequency and fatalities, both in Illinois and nationally, to half a million cases annually nationwide, and 300 deaths a day, according to the Association for Professionals in Infection Control and Epidemiology. The disease adds an estimated $32 million a day in health care costs nationally.

C. diff. has also increased among younger patients and has outpaced the spread of MRSA, or methicillin-resistant Staphylococcus aureus.

Three Chicago-area doctors are leading the fight against this deadly disease in the lab, in hospitals and among patients. And some doctors and patient advocates say hospitals need to do more to protect their customers.

Putting up resistance

Patients go the hospitals to get better, but that's where most people acquire C. diff. While the bacteria is found in the soil and other places in the environment, some 80 percent of infections arise in hospitals or day care facilities.

The typical patient is an older person who is taking antibiotics for some other condition, such as pneumonia or a urinary tract infection, and is exposed to C. diff.

Antibiotics kill many of the normal, beneficial bacteria in the digestive system, allowing C. diff. to bloom.

The primary symptom is diarrhea. It may be mild and go away once the patient stops taking antibiotics, or it may be treated with specific antibiotics, metronidazole or vancomycin.

But a new strain of C. diff. emerged early this decade that is resistant to treatment. There were outbreaks at hospitals in Pittsburgh and Montreal, where 118 people died.

Despite treatment, some patients keep getting recurrences of the disease.

Some develop colitis, which in severe cases can lead to toxic megacolon, a condition in which the colon shuts down. Complications can include blood poisoning, emergency surgery to remove the colon and death.

To contain the infection, patients diagnosed with C. diff. are kept isolated in their rooms. Health care workers are supposed to wear gloves and gowns while treating them, then discard them and wash their hands to prevent spreading the infection.

But C. diff. spores can live on almost any surface in a patient's room, and are not killed by alcohol jells or common cleaning agents. Only bleach can kill C. diff.

At North Shore University Health System in Evanston, Dr. Lance Peterson, director of microbiology and infectious disease, helped institute a program three years ago to fight the spread of the disease.

Once workers started cleaning hospital rooms with bleach - including privacy curtains, which are suspected to be significant carriers - it cut the infection rate in half throughout the system.

But the longer a patients stays in a hospital, he noted, the greater the chance they have of contracting the disease.

In the lab

For 20 years, Doctors Stu Johnson and Dale Gerding have been working together to find a way to fight C. diff.

Johnson works with patients at Loyola University Medical Center in Maywood, where he successfully treated Frances Dean after she caught the bug elsewhere.

Gerding works in the lab at Hines Veterans Administration Medical Center, where technicians use DNA fingerprinting to identify the deadly strain of C. diff. The technique is so rare that pharmaceutical companies and more than 100 hospitals around the country use the Hines lab to see if they have the superbug.

But the two doctors are going beyond identification to a new treatment.

They have developed a nontoxic strain of C. diff. that crowds out the renegade strain. When given to hamsters, the treatment has cut the fatality rate from nearly 100 percent to zero.

Later this year, the two plan to offer their beneficial bug to patients in a trial to see if it's safe in humans. If effective, it would be given to older patients who are on antibiotics, as a preventive measure.

Natural 'pro-biotics" such as Florastor yeast may help some patients, but the doctors remain skeptical because it hasn't been proven effective enough for FDA approval.

Hospital's role

Some consumer advocates, including Consumers Union and the Committee to Reduce Infection Deaths, maintain hospitals aren't doing enough to prevent C. diff.

They've argued that requiring hospitals to publicly report infection rates would help patients choose safer hospitals and be a strong motivation for hospitals to clean up their acts.

In addition, the federal Centers for Medicare and Medicaid Services has proposed not reimbursing for treatment of C. diff., as a financial incentive to get hospitals to prevent it.

Illinois law requires hospitals to report C. diff. and MRSA infection rates, but only overall results are disclosed, not for individual facilities.

Hospitals say such reporting would not be fair to centers that handle more high-risk cases, and there is disagreement on how to gauge the risk of each case.

State Department of Public Health spokeswoman Melaney Arnold also argued public reporting of individual hospitals' infection rates could be a disincentive for hospitals to report such cases.

Betsy McCaughey, chairman and founder of the Committee to Reduce Infectious Deaths, says federal and local health authorities should do much more to make hospitals clean up, including inspections and testing surfaces for bacteria.

She noted that studies show C. diff. spores survive on patient's skin and health care workers' scrubs and hands.

"Hospital hygiene is appallingly inadequate," McCaughey said, "and causes a large number of infections."

At the U.S. Centers for Disease Control, Dr. Carolyn Gould said federal officials consider C. diff. one of the most dangerous infectious diseases at health facilities, but it's up to each state to decide whether to require public disclosure of infection rates, as some are starting to do.

"We do consider it to be a big problem, an increasing problem," Gould said. "Hospitals have a big role to play because this is a preventable illness."

<p class="factboxheadblack">How to protect yourself in the hospital</p> <p class="News">• Ask medical workers and visitors to wash their hands upon entering your room.</p> <p class="News">• Wash your own hands before eating.</p> <p class="News">• Don't let utensils touch tables or other surfaces and avoid touching your hands to your mouth.</p> <p class="News">• Avoid unnecessary antibiotics.</p> <p class="News">Sources: Interviews with doctors and Betsy McCaughey, chairman of the Committee to Reduce Infection Deaths</p> <div class="infoBox"> <h1>More Coverage</h1> <div class="infoBoxContent"> <div class="infoArea"> <h2>Stories</h2> <ul class="links"> <li><a href="/story/?id=265006">C. diff. steals an angel<span class="date">[1/19/09]</span></a></li> <li><a href="/story/?id=265007">Fecal transplant no laughing matter <span class="date">[1/19/09]</span></a></li> </ul> </div> </div> </div>