Clostridium Difficile Infections – CDI

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Taking antibiotics to fight a bacterial infection, often leads to a change in the bacteria balance in the gut. If enough of the good bacteria are killed off, bad bacteria like Clostridium Difficile (c. diff.) find the opportunity to cause a secondary infection which can be life threatening.  Older adults in health care facilities, like hospitals or nursing homes, are at a higher risk of developing complications arising from such sequence of events. According to the Centers for Disease Control and Prevention (CDC) in the USA, Preventing C. difficile is a national priority.


This infection initially manifests itself as persistent diarrhea and abdominal cramping but it can quickly progress to a full colon inflammation – colitis. A policy of a thorough hand washing by patients, facility stuff and visitors can contribute to minimize the risk of C. diff. infection (CDI). Antibiotic prescriptions, a weakened immune system, along the fact that these bacteria as found in feces are prevalent in the air, the soil, the water and even the clothing of others, works against such older age groups.


If CDI is not treated in a swift manner, diarrhea will cause dehydration which will impact kidney function, blood pressure and affect many other organs. On rare occasions it can even lead to bowel perforation or toxic megacolon. The usual course of action is to counter the disease with antibiotics that target C. diff. and where there is intestinal damage then the affected parts of the anatomy are surgically removed. The problems of the approach are many. The bacteria, C. diff., has proven very difficult to prevent and treat. Then, this course of treatment is applied on primarily aged populations who are already experiencing compromised immunity due to all kinds of other health issues. What if there was another solution to such problem?


What if there was a simple, relatively safe and low cost solution for preventing CDI? This is the question that Dr. Bradley Johnston, associate professor of epidemiology at Dalhousie University in Canada, addressed in a recent study. Probiotics, despite they are not the perfect solution for such hard to treat bacterium, they where shown to offer a credible line of defense.


The study concluded that probiotics reduced the odds of CDI by about two-thirds in both their non-adjusted and adjusted models (adjusting for age, sex, hospitalization status, use of multiple antibiotics, and exposure to high-risk antibiotics). Additionally, they found that compared to no probiotics, multi-species probiotics were more beneficial than single-species probiotics.


A different project on the same subject, conducted by Cook County Health & Hospitals System, found that a probiotic mix of Lactobacillus acidophilus, L. casei and L. rhamnosus, provided a delayed benefit in reducing CDI. During the intervention period, there was a trend toward a lower incidence in CDI in the second six months, compared to the first six months. The authors speculate that the postponed benefit could be attributed to the time required for environmental contamination with spores of C. difficile to be brought under control.


“There is an expanding number of options to prevent or treat the often serious and costly infections caused by C. difficile,” said William Trick, MD, a clinician at Cook County Health & Hospitals System and lead author of the study. “Probiotics are one option that is low cost, relatively safe, and likely beneficial in the long-run.”

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