Super Superbug C. difficile

New super superbug surpasses MRSA infection rates

Were you afraid of MRSA?

A deadly antibiotic-resistant bacterium, Clostridium difficile, a new super superbug is on the rise, which might literally take your breath away.

C. difficile kills three times as many people as MRSA

Latest figures from the Health Protection Agency show there were 55,681 cases of Clostridium difficile infection reported in patients aged 65 years and above in England in 2006. (Source: SIMeL Italy)

The bacteria are naturally present in the intestine but kept under control by other bacteria. Antibiotics can kill some of these, allowing C.difficile to take hold. Image source and other images. Click image to enlarge.

Related Links:

• Quarterly UK Clostridium difficile and MRSA figures
• Education on MRSA, C-Difficile, Latest news and infection related articles
• Infection Prevention and Control (IPAC)

The following is a Public Release note by Duke University Medical Center:

New superbug surpasses MRSA infection rates in community hospitals

ATLANTA, GA – While prevention methods appear to be helping to lower hospital infection rates from MRSA, a deadly antibiotic-resistant bacterium, a new superbug is on the rise, according to research from the Duke Infection Control Outreach Network.

New data shows infections from Clostridium difficile are surpassing methicillin-resistant Staphylococcus aureus (MRSA) infections in community hospitals.

“We found that MRSA infections have declined steadily since 2005, but C. difficile infections have increased since 2007,” said Becky Miller, M.D., an infectious diseases fellow at Duke University Medical Center.

C. difficile is a multi-drug resistant bacterium that causes diarrhea and in some cases life-threatening inflammation of the colon. The infections are currently treated with one of two antibiotics. But relapses are common and occur in one-quarter of patients despite treatment, according to Miller.

“This is not a nuisance disease,” said Daniel Sexton, M.D., director of the Duke Infection Control Outreach Network (DICON). “A small percentage of patients with C. difficile may die, despite treatment. Also, it is likely that the routine use of alcohol-containing hand cleansers to prevent infections from MRSA does not simultaneously prevent infections due to C difficile.”

Miller and her team evaluated data from 28 hospitals in DICON, a collaboration between Duke and 39 community hospitals located in Georgia, North Carolina, South Carolina and Virginia. The group tries to improve infection control programs by compiling data on infections occurring at member hospitals, identifying trends and areas for improvement, and providing ongoing education and leadership to community providers.

During a 24-month period, there were 847 cases of C. difficile infections in the 28 hospitals and the rate of C. difficile infection was 25 percent higher than the rate of infection due to MRSA.

“C. difficile is very common and deserves more attention,” she said. “Most people continue to think of MRSA as the big, bad superbug. Based on our data, we can see that this thinking, along with prevention methods, will need to change.”

In the past, hospitals were focused on MRSA and developed their prevention methods on MRSA as the issue, Sexton said.

“I have always thought that we need to be looking more globally at all the problems and this new information about C. difficile provides more data to support that,” he said.

C. difficile has been a low priority for hospitals, but now it is relatively important priority, Sexton said.

“The key is to develop prevention methods aimed at C. difficile while still maintaining the success we have had with MRSA,” Miller said.

Contact: Erin Pratt
erin.pratt@duke.edu
Duke University Medical Center

Related Links:

• “Flesh Eating Bacteria” Linked to NSAIDs
• Should We Be Afraid of MRSA?
• MRSA: ACT II
• NZ Sees Surge in Flesh-Eating Disease Cases

“Flesh Eating Bacteria” Linked to NSAIDs

Global Health Alert  Bulletin # 30 – New Zealand cases of “flesh-eating” disease have surged by 300 percent

Flesh Eating Bug is linked to Nurofen, and similar non-steroidal anti-inflammatory (NSAIDs) medicine including Voltaren

Caution has also been issued on using ibuprofen in chickenpox!

Preoperative view (NF Patient)

Areas of blistering and skin necrosis became evident 12 hours after patient was admitted to hospital with lower abdominal pain, swelling of the labia and erythema across the lower suprapubic area. Photo: The New Zealand Medical Journal.

Post debridement defect

Post debridement (removal of infected tissues) photo. Image source: The New Zealand Medical Journal.

What is Necrotizing Fasciitis, NF  [commonly know as flesh-eating disease]

Necrotizing fasciitis (NF), commonly called flesh-eating disease or flesh-eating bacteria, is an infection of the deeper layers of skin and subcutaneous tissues.

• Type I infection is a polymicrobial infection.
• Type II infection is  a monomicrobial infection.

Many types of bacteria can cause necrotizing fasciitis

• Group A streptococcus (Streptococcus pyogenes)
• Staphylococcus aureus
• Vibrio vulnificus,
• Clostridium perfringens
• Bacteroides fragilis

Historically, Group A streptococcus has been responsible for  most cases of Type II infections. However, since about 1999, another serious form of monomicrobial necrotizing fasciitis,  the methicillin resistant Staphylococcus aureus (MRSA) bacterium has struck with increasing frequency.

What the bugs do!

“Flesh-eating bacteria” [they don’t actually eat flesh]  destroy skin and muscle tissue by releasing toxins (virulence factors), which include streptococcal pyogenic exotoxins.

Causes

• Surgical procedures
• IV infusions and IM injections
• Minor insect bites
• Superficial wounds
• Local ischemia and hypoxia especially in patients with diabetes and cancer (and other systemic illnesses)
• Up to 40 percent of the patients in various series were alcoholics
• The use of nonsteroidal anti-inflammatory agents (NSAIDs), such as Nurofen, Vultaren and Ibuprofen
• Complications arising from varicella infections

NF Symptoms

• Infection begins locally, at a site of trauma.
• Infection may occur as the result of surgery, minor scratches, or even non-apparent.
• Signs of inflammation may not be apparent if the bacteria are deep within the tissue, especially in the early stages,

• Intense pain that may seem excessive given the external appearance of the skin.
• As the disease progresses, tissue becomes swollen, often within hours.
• Diarrhea and vomiting.
• Signs of inflammation such as redness and swollen or hot skin show very quickly, unless infection is deep.
• Skin color may progress to violet and blisters may form, with subsequent death of the subcutaneous tissues.
• Fever and appearance of severe illness.
• The infection will rapidly progress, and will eventually lead to death, unless treated.
• Mortality rates are as high as 73 percent when left untreated.

Treatment

• Aggressive surgical debridement (removal of infected tissue), which  is always necessary to keep the disease  from spreading, and is usually the only treatment available.
• A combination of intravenous antibiotics including penicillin, vancomycin and clindamycin.
• Hyperbaric oxygen treatment, when available, as  adjunctive therapy,
• Negative pressure wound therapy (NPWT, also known as vacuum assisted closure).
• Amputation of the affected organ(s) .
• Skin grafting to cover open wounds

MRSA

MRSA [Methicillin-resistant Staphylococcus aureus] was discovered in the United Kingdom in 1961, but it is now a global concern. MRSA (also known as CA-MRSA, community-acquired MRSA, and HA-MRSA, hospital-acquired MRSA) is a variation of a common bacterium, which has evolved as a “superbug” with the ability to resist treatment with antibiotics, including methicillin and penicillin.

According to Centers for Disease Control and Prevention (CDC), MRSA is responsible for 94,000 serious infections and nearly 19,000 deaths each year in the United States. [In comparison, the AIDS virus killed about 12,500 Americans  in 2005. ]

Causes

MRSA is a strain of Staphylococcus aureus (S. aureus) bacteria. S. aureus is a common type of bacteria that normally live on the skin and sometimes in the nasal passages of healthy people. MRSA refers to S. aureus strains that do not respond to some of the antibiotics used to treat staph infections.

The bacteria can cause infection when they enter the body through a cut, sore, catheter, or breathing tube. The infection can be minor and local (for example, a pimple), or more serious (involving the heart, lung, blood, or bone).

Serious staph infections are more common in people with weak immune systems. This includes patients in hospitals and long-term care facilities and those receiving kidney dialysis.

MRSA infections are grouped into two types:

• Healthcare-associated MRSA (HA-MRSA) infections occur in people who are or have recently been in a hospital or other health-care facility. Those who have been hospitalized or had surgery within the past year are at increased risk. MRSA bacteria are responsible for a large percentage of hospital-acquired staph infections.

• Community-associated MRSA (CA-MRSA) infections occur in otherwise healthy people who have not recently been in the hospital. The infections have occurred among athletes who share equipment or personal items (such as towels or razors) and children in daycare facilities. Members of the military and those who get tattoos are also at risk. The number of CA-MRSA cases is increasing.

MRSA Symptoms

Staph skin infections cause a red, swollen, and painful area on the skin. Other symptoms may include:

• Drainage of pus or other fluids from the site
• Fever
• Skin abscess
• Warmth around the infected area

Symptoms of a more serious staph infection may include:

• Chest pain
• Chills
• Cough
• Fatigue
• Fever
• General ill feeling (malaise)
• Headache
• Muscle aches
• Rash
• Shortness of breath

Related Links:

• Should We Be Afraid of MRSA?
• MRSA: ACT II
• Global Health Alert: New Zealand MRSA Infections Up 3500 pct
• NZ Dairy Goliath FONTERRA Killing Rainforest
• NZ Sees Surge in Flesh-Eating Disease Cases
• New Zealand Visitor Health Warnings

The above information was sourced from the CDC, MedLine Plus and other sources.