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The fight against the swine flu seems to be having another positive effect in Quebec hospitals — combating the deadly C. difficile bacteria, Dr. Alain Poirier, the province’s chief public health officer, said Friday.

Last month, Quebec hospitals registered their lowest rate of infections from C. difficile in five years. And the swine flu pandemic may be partially responsible, Poirier said.

In October, there were 4.3 infections for every 10,000 patients in hospital — the lowest level since the province began closely tracking the C. difficile bacteria five years ago, Poirier said.

A major change in hospitals between then and now is that visitors and patients are constantly being reminded to wash their hands because of the H1N1 virus.

"Generally speaking, all the population has now understood that washing your hands is good for influenza," Poirier said. "But it's also good for a lot of other diseases transmitted by contamination of your hands."

Quebec began tracking C. difficile after a deadly epidemic in 2003, when most of the victims were elderly patients already in hospital. The bacterial spores are very difficult to clean off or kill.

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There is another outbreak of the Clostridium difficile bacterial infection at Nanaimo Regional General Hospital.  Six months ago, the Vancouver Island Health Authority confirmed an end to an earlier C. difficile outbreak that began in July 2008. That outbreak affected nearly 100 patients and was directly responsible for five deaths.

Dr. Martin Wale, medical director for infection prevention and control, said C. difficile cases are again higher than expected at the Nanaimo hospital.

From mid-October to mid-November, NRGH saw 11 cases of C. difficile, well above the expected average of five patients with C. difficile at any one time.  As of Tuesday, Wale said there are seven patients in isolation at NRGH with the infection, adding that two patients acquired the infection from the community.  The health authority’s outbreak protocol requires enhanced cleaning, including a top-to-bottom cleaning of the entire hospital and more powerful cleaning chemicals.

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According to Science Daily, five genetic regions have been identified that are unique to the most virulent strain of Clostridium difficile (C. difficile), the hospital superbug. Researchers writing in BioMed Central's open access journal Genome Biology studied the genome of the bacterium, looking for genes relating to motility, antibiotic resistance and toxicity.

Brendan Wren from the London School of Hygiene & Tropical Medicine worked with a team of researchers at The Wellcome Trust Sanger Institute to compare the genomes of three strains of the bacterium, the hypervirulent '027' strain, an historic, non-epidemic 027 strain and one less related and also non-epidemic '630' strain.

He said: "C. difficile is the most frequent cause of nosocomial diarrhoea worldwide. In the past five years a new group of highly virulent C. difficile strains has emerged to cause outbreaks of increased severity in North America and Europe. Several studies have shown that patients infected with these '027' strains have more severe diarrhoea, higher mortality and more recurrences. This study provides genetic markers for the identification of 027 strains and offers a unique opportunity to explain their emergence."

The researchers found that the 027 strains had considerable genetic differences compared to the non-epidemic 630 strain, which may relate to the observed phenotypic difference in virulence. Additionally, five genetic regions appear to have accumulated over the last 20 years in the modern day epidemic 027 strain, compared to its historic counterpart.

According to Wren, "The observed gene differences between these strains might individually or collectively explain why modern 027 strains are more likely to be epidemic and could explain the higher case-fatality ratio and persistence associated with infection by these strains."

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As we’ve been following both Clostridium difficile (C. diff) and Meticillin Resistant Staphylococcus Aureus (MRSA), we’ve noted that both Superbugs get a lot of attention in the United Kingdom.

We are not sure if this is ever going to figure into the big health insurance reform debate in the United States, but public hospitals in England and Scotland appear to be places you might want to avoid if you want to escape both C. diff and MRSA.

For example, the ”Registrar General” in Scotland just reported that C diff claimed the lives of 248 last year, up 12.7 percent. What they call “the hospital infection” contributed to the deaths of another 517 Scots.

MRSA killed another 48 Scots in 2008, down 8 percent from the year earlier.

Last year started with a C. diff outbreak at the Vale of Leven Hospital in Dunbartonshire, causing death rates to peak in the first half of the year, and then decline some.

That was “cautious grounds for optimism,” according to Health Secretary Nicola Sturgeon, but not a reason to be complacent. The government is installing “an electronic bed management system” and “infection tracking software” to combat the Superbugs in the public hospitals.

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Cepheid (CPHD) Monday announced it has received clearance from the U.S. Food & Drug Administration (FDA) to market its Xpert C. difficile test, an on-demand molecular diagnostic test designed for 45-minute detection of the bacterium that causes Clostridium difficile infection or CDI.

The Xpert C. difficile test is the first test for CDI to deliver both rapid turnaround and a high degree of accuracy, the company said.

"The previous lack of an accurate and rapid diagnostic test for CDI has greatly impeded our ability to halt the increasing rate of CDI, which has taken a severe turn in the past several years. Patients can have their first diarrhea symptoms on a Monday and be dead by Thursday," said Dale Gerding, MD, professor of medicine, division of infectious diseases, Loyola's Chicago Stritch School of Medicine.

C. difficile, a spore-forming bacterium, is now challenging Methicillin-resistant Staphylococcus aureus (MRSA) as the most prevalent Healthcare Associated Infection (HAI) in the United States. A recent study published by the Association for Professionals in Infection Control and Epidemiology (APIC) found that on any given day there are more than 7,000 patients in the United States suffering from CDI, causing the deaths of approximately 300 patients per day. The disease, which can range in severity from mild to severe diarrhea, pseudomembranous colitis, toxic megacolon, sepsis, and death, is costing American healthcare institutions up to $51.5 million per day.

Based in Sunnyvale, Calif., Cepheid (Nasdaq: CPHD) is an on-demand molecular diagnostics company that develops, manufactures, and markets fully-integrated systems and tests for genetic analysis in the clinical, industrial and biothreat markets. 

Read more in the company's press release.

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Medscape, the online medical newsletter from WebMD, is reporting on recent safety labeling changes to give the public more information about Clostridium difficile.

“The US Food and Drug Administration (FDA) has approved safety labeling revisions to advise of an interaction between amoxicillin and certain urine glucose tests, and to include patient information regarding the risk for the development of Clostridium difficile–associated diarrhea more than 2 months after completion of treatment with a prepackaged regimen of lansoprazole, amoxicillin, and clarithromycin tablets,” its reports.

“The agency also warned that amoxicillin, clarithromycin, and other antibiotics have been linked to a risk for Clostridium difficile–associated diarrhea (CDAD) that may range in severity from mild diarrhea to fatal colitis and occur more than 2 months after treatment is completed. Because hypertoxin-producing strains of C difficile can be refractory to antimicrobial therapy, they are associated with increased morbidity and  mortality rates and may require colectomy."

Read the rest in Medscape.

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 This just in from across the pond:

"In England and Wales, the national health statistics in 2007 showed that there were 8,324 death certificates which named Clostridium difficile. This is a bacterium which causes severe diarrhoea in humans and animals as the underlying cause of death, a 28 percent increase from 2006."

Janet Nale of the Department of Infection, Immunity and Inflammation has been investigating the contributing factors that make Clostridium difficile so aggressive to direct treatment.

She will present her research at the Festival of Postgraduate Research tomorrow on Thursday, June 25th in the Belvoir Suite, Charles Wilson Building at the University of Leicester between 11:30 am and 1 pm. This event is open to the public and is free to attend.  We will be looking for what she has to say.

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 If there were a bully in the neighborhood, the Irish way to deal with the situation might be to find  somebody bigger to knock him or her out. That appears to be the tack the University College Cork (UCC) is taking when it comes to the dangerous Clostridium difficile.

A UCC research team plans to fight hospital superbugs with designer bacteria that they hope will be tougher than Clostridium difficile.

In other words, the Irish researchers plan to conduct germ warfare against the very superbugs that are proving resistance to the world’s best antibiotics. They want to stop C difficile and the infamous MRSA.

The approach UCC’s Alimentary Pharmabiotic Centre (APC) is taking is to add extra genes to give their designer bacteria an edge over C difficile.  The APC looks for “good bugs” in the most unexpected of places. Gut tissue samples recovered from consenting patients offer a ready supply, but so too does the contents of an infant’s nappy. “They are quite good sources for probiotics,” Dr. Roy Sleator told The Irish Times.

For more on germ warfare against the superbugs, check out the rest of the story in today's IT here.

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The BBC is reporting that two elderly patients suffering from Clostridium difficile  have died at Dr. Grey's hospital in Moray, Scotland.

Six other patients at the hospital have contracted Clostridium difficile.  Additionally, a higher than usual number of patients are suffering from gastrointestinal illnesses.

An outbreak control team has been set up.

The health board said the deaths happened in April and that both the patients had been frail.

A spokesman said the infection was the main cause of death in one of the patients and was a contributory factor in the second death. 

More information is in the BBC article.

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