Web Zap*Germs Archive

June 06, 2005

Clostridium Kills 12 in UK Hospital - May Be From US or Canada

Twelve patients have died at Stoke Mandeville Hospital, in Buckinghamshire, UK since late 2003, of a severe infection caused by Clostridium difficile. The gut bacteria can "go bad" when intestinal bacteria balance is upset by antibiotics, producing a toxin that causes severe diarrhea. It's believed that this killer strain of C. diff. may be the same one that has been killing people in the US and Canada.

From The Times Online:
The strain identified in Quebec carries 20 times as much toxin as previous C. diff strains, and has also been found across the United States. People infected suffer much more serious symptoms than with more familiar strains. In addition to diarrhoea, they have high fevers and high white blood cell counts. They do not respond to treatment as quickly, and may need surgery — for removal of the colon, for example — which was seldom needed in the past.

A spokeswoman for the [UK Health Protection Agency] said that tests now going on would determine if the Stoke Mandeville strain was the same. If so, there are dangers outside hospitals as well as inside them. In the US and Canada, some patients have caught C. diff without setting foot in a hospital, suggesting that it may have reached the community.
  • The bacterium produces two toxins, called A and B. Both appear to be involved in causing symptoms of the disease. Experiments show that some antibiotics increase toxin production by a factor of eight

  • The bacterium is transmitted by patients or staff to the food of other patients. One study found that 59 per cent of staff carried the bacterium on their hands

  • C. diff produces long-lived spores that can persist on hands, clothes, bedding and surfaces, making elimination hard.

  • Stoke Mandeville's struggle with hospital-acquired infections has apparently been underway for some time -- Paul Gillet, an infection specialist, reportedly resigned from the hospital after attempting to reduce the hospital's infection rate.

    The Independent has made some interesting editorial remarks, including:
    [H]ospitals suffer from more cases of bacterial infections as the patients in them get older and sicker. This is demography at work, not declining standards of health care. As the nation ages, improvements in medicine are keeping us alive for longer.

    Many of these factors are reflected in the outbreak at Stoke Mandeville, the only hospital to be affected by this virulent new strain of Clostridium difficile. Many patients there remain on the wards for months at a stretch and the average age of those who died was 85.
    There is no doubt that the spread of Clostridium difficile is directly linked to cleanliness. One problem here is that the routine practice of staff washing their hands with alcohol gel works against MRSA but not against Clostridium difficile. More washing of hands in soap and water, as well as better cleaning of the wards, will help to stop an infection of this type from spreading.

    An additional, quite separate, factor is the abuse and misuse of antibiotics, which is a growing medical problem worldwide.

    More: C. diff Q&A

    Update 09 Jun 2005: Bioquell, which has had success cleaning a hospital harboring VRE, puts their best foot forward in recommending their disinfection service to Stoke Mandeville, though I'm sure they meant to say "complement" instead of "compliment."


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