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New Clostridium Difficile Strain Offers Promise

Created Jun 08 2015, 8:00 PM by Lippincott Solutions
  • infection
  • CDI
  • Healthcare-associated infection
  • Clostridium difficile

Tuesday, June 9, 2015

Clostridium difficile, commonly known as C. diff., is the most common cause of healthcare-associated infection in the United States. According to the Centers for Disease Control and Prevention (CDC), in 2011, nearly one-half million individuals developed C. diff. infection (CDI); of those, 29,000 individuals died within 30 days of their initial diagnosis.

Poor antibiotic prescribing practices increase the risk for CDI. More than half of all hospitalized patients receive an antibiotic during their hospitalization. Studies show that 30% to 50% of those prescribed antibiotics are unnecessary or inappropriate for the infecting organism, unnecessarily increasing patients’ risk for CDI.

Deadly form

C. diff. is a spore-forming, Gram-positive bacillus that produces two endotoxins, toxins A and B. A virulent strain, known as BI/NAP1/027, has emerged that produces an increased amount of toxins A and B along with an additional toxin, known as binary toxin. In addition to being more virulent, this strain is commonly resistant to treatment normally used to treat CDI.

The key signs and symptoms associated with CDI include:

  • Abdominal pain or tenderness
  • Fever
  • Loss of appetite
  • Nausea
  • Watery diarrhea.

The virulent form can quickly cause pseudomembranous colitis, toxic megacolon, colon perforation, sepsis, and death.

Shed and spread

C. diff. is shed in the feces of a patient who is colonized or infected with the organism. Surfaces or items that become contaminated with feces may become a reservoir for the C. diff. spores. C. diff. spores can survive on surfaces or items for many months; they’re spread most commonly through the hands of health care workers who have touched these contaminated surfaces or items.

Fighting fire with fire

In nearly 20% of patients, CDI resolves within 3 days of discontinuing antibiotic therapy. When it doesn’t resolve, antibiotics, such as metronidazole, oral vancomycin, or fidaxomicin are prescribed for about 10 days.

However despite treatment, 25% to 30% of patients experience recurrence. Recently researchers came up with a new strategy against CDI recurrence…fighting the toxigenic form of C. diff. with a new nontoxigenic form. In a randomized, double-blind, placebo-controlled, dose-ranging study the new C. diff. strain, known as NTCD-M3, was administered orally to 173 patients who had recovered from the initial or the first recurrence of CDI. Patients were randomly assigned to one of four treatments:

  • 104 NTCD-M3 spores/day for 7 days
  • 107 NTCD-M3 spores/day for 7 days
  • 107 NTCD-M3 spores/day for 14 days
  • Placebo for 14 days.

The study revealed CDI recurrence rates of 30% in patients who received the placebo compared to 5% in patients who received 107 NTCD-M3 spores/day for 7 days. Further evaluation of the data revealed that CDI infection rates weren’t dose dependent.

So how does NTCD-M3 fight the toxigenic form? It’s believed that it adheres to the GI tract and uses the same metabolic processes as the toxigenic form. After it establishes itself in the GI tract, it’s able to outfight the toxigenic form. It isn’t clear if the effects of NTCD-M3 are lasting, but its use has shown promise in preventing CDI recurrence. Great news for those who suffer from CDI and the threat of recurrence.

What are you doing to fight CDI in your facility?