Tag Archive for: C. diff

Fearsome Twosome: C. Diff and Clade A

/in /by

Clostridioides difficile, C. diff for short, is a serious bacterial infection typically acquired after antibiotic treatment in a hospital. Antibiotics disturb the microbiome balance, and as a result, a bacterium that typically may not be a threat becomes one. But C. diff is not just a single bacterium.

In a recent paper, researchers from London sequenced and compared the DNA of 906 strains of C. diff—906! They reported that 761 strains came from humans living in 33 countries. They found that C. diff is still evolving. In fact, one species has adapted to living in hospitals; the type of C. diff that seems to dominate has been termed Clade A. It didn’t develop overnight; it took many years, but it developed specifically for the hospital environment.

Clade A has two characteristics that are a problem for us. It’s resistant to anti-bacterial cleaning products and therefore survives after cleaning. Even more critical is that this form of C. diff has developed the ability to use sugar as a fuel. The researchers actually tested modifying the diets of mice exposed to Clade A and found that it thrived with a sugary diet.

Where does that leave us? I think that further research should explore changing the typical hospital diet including elimination of sugars and simple carbohydrates. The cleaning part is more complicated. Heat will kill it, but that applies to only hospital instruments; for instance, you can’t heat a door handle or a bed’s handrail or to a high enough temperature to kill bacteria. A different solution must be discovered.

For now, in addition to the normal antibacterial precautions, I think it’s smart to greatly limit simple carbs post-surgery or when you’re spending a lot of time in a hospital.

What are you prepared to do today?

        Dr. Chet

Reference: www.nature.com/articles/s41588-019-0478-8.

Probiotics Can Cut C. Diff Rates

/in /by

The authors reported that there were 39 studies included in the Cochrane review; 33 on adults and six on children. They included studies that were in-patient, out-patient, and using varying strains and quantities of probiotics. Here’s what they found.

There was moderate evidence that the use of probiotics together with the administration of antibiotics did reduce the occurrence of C. diff. The risk of getting the C. diff infection was reduced by 60% when compared to control subjects or those who were not treated; typically about 4% of the subjects got C. diff when treated by antibiotics, and it was reduced to 1.5% when probiotics were given concurrently. The phrase “moderate evidence” is one I haven’t used before. It’s generally specific to Cochrane Reviews and is assessed using various factors, ending with a number that reflects the quality of studies included in the analysis.

There was also a reduction in abdominal cramping and diarrhea in those subjects who were given probiotics with their antibiotics compared to those who didn’t get probiotics. In this case, the quality of the research was considered of poor quality. Does that mean that the probiotics were ineffective? No. More than likely it was due to the subjective assessments of pain by individuals. You can test stool to see if C. diff is present, as would have been done in the other part of the research, but relying on people’s self-assessment of pain is less objective. (That’s why my website offers the pain scale developed by the Missoula Project; it has physical activity descriptors that make it easier to determine where you are on the scale. Look for it on the Health Info page.)

Where does that leave us? I’ll finish on Saturday with some recommendations for the use of probiotics.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.

 

Can Probiotics Prevent C. Diff?

/in /by

Probiotic research is hot right now. Researchers are trying to figure out what these beneficial microbes can do for our health for a number of reasons. What types of infectious diseases can be prevented, whether food-borne or not? What are the best microbes to treat specific conditions? After all, there are estimated to be around 5,400 different bacteria, yeasts, and fungi. Which ones are best for an E. coli infection? Or salmonella? How about inflammatory bowel disease? Can probiotics benefit other organs in the body by not allowing negative bacteria to enter the blood stream? The questions are almost endless at this point.

We may be starting to get some answers. This week I’m going to focus on the role probiotics may play in preventing clostridium difficile, commonly known as C. diff, infections in people who’ve had to take antibiotics for different diseases. Antibiotics are beneficial when we need them but they do not discriminate; they kill microbes whether they’re beneficial or not. As a result, our gut bacteria—our microbiome—can be decimated. As a result, people who are on heavy doses of antibiotics are prone to C. diff infections. While treatable in most cases, it can have devastating effects on some people including severe pain, cramping, and uncontrolled diarrhea. Not fun!

The authors of a recent paper examined whether probiotics, administered with courses of antibiotics, helped to reduce the rate of C. diff in patients. A Cochrane Review paper examines all available studies from around the world, ranks the quality of the research, and analyzes all the data. Some of the authors of that paper published a summary of that review in JAMA. We’ll take a look at the results on Thursday.

DrChet.com

Tomorrow is the anniversary of the launching of the new DrChet.com website. This past weekend I was speaking in Texas, and several people who are Insider members said that the free monthly Insider Conference Calls were very informative and helped their personal health and the health of their family and clients. Think about becoming an Insider as we begin our second year of memberships.

What are you prepared to do today?

Dr. Chet

 

References:
1. JAMA. doi:10.1001/jama.2018.9064.
2. Cochrane Database Syst Rev. 2017 Dec 19;12:CD006095.