Clostridium difficile is one of the leading causes of nocosomial (hospital-acquired) infections in the United States. It is of growing concern not only because of the increasing incidence of C. difficile Infections (CDI), but also because there is a new, hyper-virulent strain of C. difficile called 027/NAP-1/BI. This strain is harder to treat than typical C. difficile, and can lead to more debilitating, recurring bouts of CDI that may often be fatal. Elderly and immune-compromised individuals are particularly susceptible to CDI.
CDI typically occurs when patients ingest the spores produced by Clostridium difficile. These patients are usually on an antibiotic regimen to treat some other infection and completing the antibiotic regimen can sometimes inadvertently destroy the normal bacteria that would prevent C. difficile from becoming established even if ingested during hospitalization. Therefore, when the patients on antibiotic regimens ingest the C. difficile spores they are more likely to actually develop a CDI infection.
These spores are highly resistant and can survive the acidic environment of the stomach. After they pass through the stomach C. difficile spores can then establish themselves in the large intestine where they revert back to the cellular or vegetative form of the bacteria. Once established they produce potent toxins that destroy the intestinal lining, resulting in irritation and severe diarrhea.
Scientists are trying to find new and more effective ways of preventing and treating CDI. A potential treatment is the use of probiotics. The goal is to allow the beneficial microbes in the probiotic cocktails to colonize the gastrointestinal tract, and thus prevent the more harmful C. difficile from becoming established even if patients are exposed to them. If successful, this approach would prevent patients from developing an initial CDI.
One scientist who has investigated the efficacy of this probiotic approach to CDI is Dr. Marisel Segarra-Newnhman. Dr. Segarra-Newnham is a Clinical Pharmacy Specialist in the Infectious Disease at the Veteran’s Affairs Medical Center on Military Trail in West Palm Beach, FL. In a recent article Dr. Segarra-Newnhman noted that additional research needs to be conducted on the efficacy of probiotics to prevent CDI because probiotics may actually result in additional complications for patients who are immunosupressed. This would include patients who are on antibiotic therapy for some other infection.
In addition to the potential use of probiotics other scientists are even considering the controversial treatment of Fecal Transplantation. As the name suggests, the treatment involves taking the fecal matter from a healthy patient and transplanting it into the intestinal track of a patient who is susceptible to CDI. The goal is to transplant beneficial microbes from one person to another. This unconventional treatment is actually gaining some popularity in the medical field and has already been used to treat some cases of CDI in Canada.
A more classical approach to preventing CDI is the development of a vaccine that would prevent initial infections even if patients are exposed to the bacteria. The U.S Food and Drug Administration (FDA) recently granted fast-track status to a new vaccine that was developed by Sanofi Pasteur. The vaccine is an investigational vaccine against Clostridium difficile and if approved, it would be the first of its kind to specifically prevent CDI.