January 12, 2012

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C. difficile Diarrhea Can Be Linked to PPIs, FDA Says

It seems easier to explain to patients why they "don’t really need that antibiotic," thanks to the public health campaign on potential harm from, and the lack of efficacy of, antibiotics in certain situations such as viral infections. Yet, in the midst of this apparent meeting of the minds between doctors and patients, another superbug has emerged that is changing the game again.

By Dr. A. Maria Hester

A hypervirulent strain of Clostridium difficile, known as BI/NAP1/027, or NAP1 for short, has made the necessity of appropriate antibiotic prescribing more urgent than ever. According to Dr. Carolyn Gould, a medical epidemiologist in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention in Atlanta, this strain produces up to 15-20 times more toxin than other strains.

We all know about antibiotics, which wipe out a lot of normal bowel flora, and thus predispose to C. difficile. Even many patients realize that the use of antibiotics can lead to new infections, particularly among women, who frequently get yeast infections when taking antibiotics. Now, with current concerns that the widely used proton pump inhibitors also predispose to this condition, it will be even harder to control C. difficile infection rates. If a patient has been taking a proton pump inhibitor for a long time without a clear indication (sometimes it’s just because he/she is "used to taking it"), they should be given a trial off this medication. If they do well without it, fine. If not, it can always be resumed.

Photo courtesy CDC/D.Holdeman   It may not be possible at this time to completely eradicate C. difficile (shown here), but patients and their families can be educated about risk factors and how to avoid spreading the infection.

Frustration is compounded in patients who get C. difficile again and again. And, naturally, their family members often become concerned that they, too, may come down with this potentially devastating infection. While we may not be able to completely eradicate this microorganism, we can help educate patients and their families about risk factors and help them avoid spreading the infection should they develop it.

Hygiene remains of paramount importance. It is well known that hand-washing, not alcohol scrubs, is the best way to minimize the transmission of C. difficile between patients. But there is much more. The Mayo Clinic initiated a project to cut the rate of C. difficile infections by asking its workers to simply wipe down high-touch areas with bleach wipes twice daily. This simple step all but eliminated infections in units that had been averaging five to seven infections per month. While there may not be a randomized controlled clinical trial to support using the same procedure at home, it stands to reason that when patients with C. difficile leave the hospital, cleaning appropriate surfaces in their homes with a bleach solution may help kill the organism in their homes as well, thus helping the patients as well as their families.

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