L ast spring I covered new findings on how antibiotic overuse continues to spur the emergence of "superbugs," drug-resistant microbes, such as methicillin-resistant Staphylococcus aureus (MRSA), that seem to defy modern medicine. Now we have another one to worry about -- Clostridium difficile (C. difficile), a toxin-producing bacterium long associated with elderly folks in hospitals and nursing homes that has now morphed into a virulent epidemic strain, threatening people of all ages. C. difficile can range from an annoyance, causing mild symptoms such as watery diarrhea, fever, nausea and cramps, to more severe troubles including inflammation of the colon, sepsis (blood poisoning), kidney failure and, in the worst cases, death.

As its name suggests, C. difficile can be difficult to treat. It is a real challenge to control in hospitals, since it produces spores that are difficult to eradicate and are easily passed from one person to another. And, as with MRSA, its antibiotic resistance has led to the selection of more virulent strains of C. difficile, leading to hospital outbreaks all around the United States.

IS IT AN EPIDEMIC?

For insight into C. difficile and how we can protect ourselves, I spoke with Cliff McDonald, MD, chief of the Prevention and Response Branch in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC). "C. difficile has been known about as a cause of human disease for 30 years," said Dr. McDonald. "It was previously uncommon, but it has now reached epidemic proportions." He estimates the number of C. difficile cases may reach 500,000 annually (including up to 30,000 deaths), reflecting approximately a five-fold increase since 2000.

The cause of the C. difficile epidemic is a newly identified strain called NAP1, which, when tested in the laboratory, produces 16 times more toxin A and 23 times more toxin B than other common strains. NAP1 is more resistant than other strains to the fluoroquinolones, a group of antibiotics that are commonly used to treat pneumonia in hospitals. "The overuse of antibiotics and the general resistance to fluoroquinolones has given NAP1 C. difficile a one-up on other strains," said Dr. McDonald. "Because it had a selective advantage over susceptible strains, it quickly spread and became epidemic in health care facilities."

ARE YOU A CARRIER?

About 3% to 5% of healthy people actually carry C. difficile in their large intestines, Dr. McDonald explained, but typically without symptoms -- it is held in check by the "good" bacteria that we also harbor, at least optimally. Ironically, this is often disturbed by the use of antibiotics, leaving some people vulnerable and allowing C. difficile to flourish.

Typically cases of C. difficile originate in hospitals, spread unwittingly by healthcare workers as they handle infected patients and then touch other patients and medical equipment or other surfaces. C. difficile spores are unaffected by most hospital disinfectants... nor are they inactivated by alcohol-based hand sanitizers commonly in use. Special measures are required in hospitals to keep C. difficile infection from spreading.

Making matters worse is that C. difficile has a high recurrence rate. One out of five (20%) patients who get sick with it experience a recurrence and the chances increase following subsequent recurrences. Some cases are so severe that the only option has been removal of the affected part of the colon. "People can actually have a mild infection the first time and then die of a recurrence," said Dr. McDonald.

TIPS FOR CONSUMERS

We can do our part, suggested Dr. McDonald, by keeping our antibiotic usage to a minimum. "As a society we need to rethink the way we approach antibiotics," he cautioned. "People need to understand that antibiotics are not vitamins and they are not sugar pills -- they can carry some very significant risks, and C. difficile is one of them. Don't push for a prescription when you don't really need one." In addition...

Wash hands after using the bathroom and before eating or touching your face -- C. difficile must be ingested in order to cause disease. Dr. McDonald notes that it's important to remember that alcohol-based sanitizers don't work against C. difficile, so it may be better to wash with soap and water at these times.

Keep your household clean. If you are exposed to C. difficile, or indeed to any individual with diarrhea, scrupulously clean all exposed surfaces in the room and/or that you or that person may have touched. Use a solution that is 1/10 household chlorine bleach, 9/10 cold water... made fresh daily... and scrub thoroughly to effectively kill C. difficile spores.

Realize that not all cases of diarrhea are C. difficile. However, if you have severe diarrhea that occurs several times a day for two or more days, see your doctor immediately. A stool test can confirm the presence of the disease.

Remember, the drugs many people take in order to feel better -- including antibiotics and, as DHN readers have heard before, proton pump inhibitors (PPIs) -- alter the natural composition in the body in many different ways, making it vulnerable to disease. Though drugs can play an important role in medicine, in the end, less medicine is often the best medicine.