July 05, 2017
Americans are increasingly falling victim to an intestinal infection that torments patients, spreads in hospital environments and places a growing burden on the nation's health care system, according to researchers at the University of Pennsylvania's Perelman School of Medicine.
In a long term analysis of a nationwide health insurance database, the research team tracked the prevalence of Clostridium difficile infections — also known as C. diff — from 2001 to 2012. Every year, about half a million Americans are affected by C. Diff, tens of thousands of them fatal cases.
The infection causes diarrhea, severe cramping, dehydration and a range of other immediate symptoms, which could potentially develop into colitis or serious inflammation of the colon. Those at the greatest risk include older adults living in health facilities and patients taking antibiotics that alter their microbiomes.
One chronic form of the ailment, known as multiple recurring C. difficile infections (mrCDI), rose by an alarming 189 percent during this time period, according to researchers. That was compared to just a 43 percent rise in common CDI, the most widespread healthcare-linked infection in the country, over the same period.
Cases of mrCDI are frequently treated using antibiotics including metronidazole, vancomycin, and fidoxamicin, though the illness recurs roughly a third of the time. In response to their findings, the research team at Penn advocates for the alternative use of fecal microbiota transplants (FMT), a common veterinary practice that involves infusing fecal matter from healthy intestines into a mrCDI patient.
“The increasing incidence of C. difficile being treated with multiple courses of antibiotics signals rising demand for fecal microbiota transplantation in the United States,” said study senior author James D. Lewis, “While we know that fecal microbiota transplantation is generally safe and effective in the short term, we need to establish the long term safety of this procedure.”
Researchers looked at more than 40 million U.S. patients enrolled in private health insurance plans to identify the rise in mrCDI, defined as cases in which at least three closely spaced courses of CDI antibiotics were used. Female patients over the age of 55 were most commonly diagnosed, with a higher prevalence among older patients who may have been exposed to medications such as corticosteroids, proton-pump inhibitors and antibiotics prior to their CDI infection.
Researchers said another possible cause for the spread of mrCDI could be the emergence of new strains of C. difficile.
Gastroenterologists believe FMT may be the most effective approach to treating mrCDI, which tends to affect individuals whose healthy gut bacteria have been diminished. The goal of such an intervention is restore a normal gut bacteria population and minimize growth of C. difficile.
A small FMT study in 2013 found that a single infusion cleared up C. difficile diarrhea in 81 percent of mrCDI patients, compared to a 31 percent success rate in patients who underwent a course of the antibiotic vancomycin. The Penn team believes further FMT research is needed to build on these promising results.
Results from the current study, funded by National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Allergy and Infectious Diseases, were published in the Annals of Internal Medicine.