Originally created 12/02/05

Bacterial illness is appearing to spread



ATLANTA - A deadly bacterial illness commonly seen in people who take antibiotics appears to be growing more common - even in patients who hadn't taken antibiotics, federal health officials warned Thursday.

The spore-producing bacteria is Clostridium difficile, also known as "C-diff." It's becoming a regular menace in hospitals and nursing homes, and last year was blamed for 100 deaths over 18 months at a hospital in Quebec.

Recent cases in four states show it's appearing more often in healthy people who haven't been admitted to health-care facilities or even taken antibiotics, according to a report published by the federal Centers for Disease Control and Prevention.

"What exactly has made C-diff act up right now, we don't know," said Dr. L. Clifford McDonald, an Atlanta-based medical epidemiologist for the CDC who was an author of the article.

The development is concerning to health officials. C-diff is a bacteria found in the colon that can cause diarrhea and a more serious intestinal condition known as colitis. It's spread by spores in feces. The spores are difficult to kill with conventional cleaners, and the bacteria has spread in many health-care settings.

C-diff has grown resistant to certain antibiotics that work against other colon bacteria. The result: When patients take those antibiotics, particularly clindamycin, competing bacteria die off and C-diff explodes.

The new report focused on 33 cases reported since 2003. Researchers said 23 involved healthy people in the Philadelphia area who were not admitted to a hospital within three months of illness.

Ten more were healthy pregnant women or women who had recently given birth who had brief hospital stays. Those reports came from four states - Pennsylvania, Ohio, New Jersey and New Hampshire.

One of the 33 patients died - a 31-year-old Pennsylvania woman who was 14 weeks pregnant with twins when she first went to the emergency room with symptoms. Despite treatment with antibiotics considered effective against C-diff, she lost the fetuses and then died.

She had been treated about three months earlier for a urinary tract infection with an antibiotic, trimethoprim-sulfamethoxazole. Ten of the other 33 patients had taken clindamycin.

But in eight of the 33 cases, patients said they had not taken any antibiotics within three months of the onset of symptoms.

The illness is still considered unusual: In Philadelphia and its surrounding four counties, the CDC estimates minimum annual incidence of disease from C-diff to be 7.6 cases per 100,000 healthy people without recent exposure to hospitals. That translates to one case of illness for every 5,549 outpatient antibiotic prescriptions.

Nevertheless, researchers think the bacteria might be increasingly prevalent. It also appears to be mutating to produce more toxins and cause more severe illness, Dr. McDonald said.