Reported by Tiffany Chao, M.D.
Surgeons have found a new treatment that may help put a stubborn hospital-acquired infection on the run.
Hospitalized patients are at risk for developing healthcare-related infections, and one of the most dreaded is Clostridium difficile colitis, a virulent bacteria that affects about 336,000 patients per year, causing diarrhea, fevers, and occasionally sepsis and death. It is easily passed around the hospital, especially since it is one of very few bacteria that cannot be killed by the alcohol-based sanitizers that are fixtures in every hospital for hand hygiene.
There has never been any medical treatment available to prevent this infection. But in findings presented Thursday at the 2012 Annual American College of Surgeons Clinical Congress in Chicago, surgeons report success using a medicine called intestinal alkaline phosphate (IAP) to prevent C. difficile infections in tests on mice.
"According to the CDC, C. difficile is linked to about 14,000 U.S. deaths every year," says Dr. Richard Hodin, a surgeon at Massachusetts General Hospital and the principal investigator of the study. "Estimates are that we spend at least $1 billion in extra costs to the health care system due to C. difficile, and probably a lot more."
The bacteria may live naturally in the colon and is kept in check by the rest of the natural, "good bacteria" in the gut. But occasionally, when patients are given antibiotics, may of the "good bacteria" get killed off and the C. difficile takes over, causing symptoms like diarrhea, fever, abdominal pain and colitis. While antibiotics typically can treat the bacteria, an unrecognized infection may progress to a dangerous disease called toxic megacolon that requires emergency surgery and a removal of the entire colon.
"The paradox is that it is caused by antibiotics, but antibiotics don't always work to cure it," says Dr. Angela Moss, a surgery resident at Massachusetts General Hospital and one of the co-authors on the study. "Then it becomes a life-threatening problem."
Unfortunately, because C. diff may be lying dormant in any person's colon, almost every patient on antibiotics can be at risk for C. difficile colitis. Researchers therefore have been searching for a way to prevent this infection before it starts.
In the study, Hodin and colleagues found that giving IAP to mice on antibiotics resulted in a 10-fold decrease in C. difficile bacteria in their stool, as well as a 10-fold decrease in in inflammatory marker called IL-1.
"We were surprised to find that this naturally occurring enzyme was a regulator of the gut flora," says Hodin. "If this works in humans, like it does in mice, then we think it could be used as an oral supplement in almost all patients who are taking antibiotics."
Fortunately, IAP is a naturally occurring gut enzyme, so it is likely completely safe to take. A previous study using IAP in patients showed no side effects. Researchers are hopeful that clinical trials in humans can soon begin, allowing progress to be made on preventing this dangerous infection.