Infection Kills 100 Quebec Patients

[dave () farber net]

___

Dave Farber  +1 412 726 9889



 ..... Forwarded Message .......
From: Megan Holbrook <megan () kapow com>
To: Dave Farber <dave () farber net>
Date: Thu, 05 Aug 2004 11:14:32 -0700
Subj: Infection Kills 100 Quebec Patients

Hi Dave -

Another interesting article for IP if you wish. A bacterial infection 
commonly found in hospitals and nursing homes has been blamed in the 
deaths of 100 patients in the past 18 months in a single Quebec 
hospital. Compared with SARS which killed 38 people in Toronto, this 
information seems like it might be worth receiving a little more 
coverage than the single article I found below in an American news 
source, an AP report on Yahoo (I've enclosed the Canadian story which 
gave more details).

I hesistate to comment on the story more, not being a doctor or 
microbiologist, but we seem to routinely overestimate danger from some 
diseases, and underestimate the dangers posed both by overuse of 
antiobiotics and by certain bacterias' growing resistance to antibiotics.

Yahoo Story:
http://story.news.yahoo.com/news?tmpl=story&cid=541&ncid=751&e=10&u=/ap/20040805/ap_on_he_me/canada_hospital_infection

Canadian Globe and Mail Story:
http://www.theglobeandmail.com/servlet/story/RTGAM.20040804.winfec20804/BNStory/National/


Microbe blamed for 100 deaths at Quebec hospital

By SHERYL UBELACKER
Canadian Press


Toronto — A bacterial agent commonly found in health-care settings has 
been blamed for the deaths of 100 patients in the last 18 months in a 
single Quebec hospital, says an infectious disease expert at the 
facility, who is calling for government action to forestall more 
outbreaks across the country.

Dr. Jacques Pepin says cases of Clostridium difficile at University 
Hospital in Sherbrooke have been steadily increasing. And the incidence 
among those most vulnerable to the disease — patients aged 65 and older 
— jumped 10-fold between 1991 and the end of 2003.

The infection has been blamed for killing 54 patients in 2003 and 
another 46 in the first six months of this year at the 683-bed hospital, 
said Dr. Pepin, lead author of a study in the Canadian Medical 
Association Journal.

Using patient records, the University of Sherbrooke researchers compiled 
cases of C. difficile and deaths from the infection over the last 14 
years. They found the proportion of patients who died within 30 days of 
diagnosis soared to almost 14 per cent in 2001 from less than 5 per cent 
in 1991.

“A lot of these patients were quite elderly people and for some of them, 
they obviously died for other reasons,” Dr. Pepin said Wednesday from 
Sherbrooke, explaining that many were being treated for other serious 
illnesses. “But ... in my opinion, the vast majority of these patients 
died directly of this infection.”

Outbreaks of C. difficile have killed almost 90 patients at several 
hospitals in both Montreal and Calgary. And more recently, a patient 
died of the disease in a hospital in Newmarket, just north of Toronto. 
In June, Quebec's chief medical officer ordered hospitals to record all 
cases of the infection so the province can determine if the disease is 
actually on the rise.

C. difficile is a garden-variety bacterium in hospitals and usually 
poses no threat to healthy people. But it can become dangerous for 
hospital patients treated with antibiotics for other illnesses, such as 
pneumonia, because the drugs kill off so-called good bacteria in the 
intestinal tract, allowing C. difficile to flourish.

It then begins secreting a toxin, said Dr. Pepin. “And it is this toxin 
which starts producing the symptoms.”

The most obvious symptom is diarrhea, which can be so severe that some 
patients lose too much fluid in their bodies and go into shock caused by 
plummeting blood pressure and then die, he said.

Dr. Pepin theorizes that the C. difficile mini-epidemics may be related 
to a greater number of older patients occupying hospital beds because of 
an aging population and the possibility that more virulent strains of 
the bacterium have developed, which produce more toxins.

“It used to be considered just something annoying. You'd get four or 
five loose stools a day ... and it wouldn't be that bad,” said Dr. 
Pepin. “But what we've been seeing for the last couple of years is much 
more severe diarrhea. So if you have 15 or 20 bowel movements a day,” 
the chance of it spreading from patient to patient is much greater.

As well, cuts in health-care dollars have meant many Canadian hospitals 
have not been renovated, making it more difficult to ensure sanitary 
conditions, he said, noting that in some Quebec hospitals, there can be 
40 patients on a ward sharing one or two bathrooms.

“The result is that in some of these old buildings, the sanitary 
conditions are intolerable. I mean, it's indecent.”

Dr. Pepin, noting that treating a single patient with C. difficile costs 
about $10,000, said funding is needed from the province to improve 
hospital infrastructure so the infection can be better controlled. But 
he also believes Ottawa must take a role as it did in helping to combat 
the SARS outbreaks last year that killed 44 Canadians — far fewer than 
have died from C. difficile.

“I think what would be needed at the federal level would be some 
research to look at better treatments and better infection-control 
measures,” he said. “There is certainly a possibility that it might 
spread outside of Quebec. The potential for transmission is there.”

While it is not mandatory to report cases of C. difficile to government 
agencies, Health Canada is helping to fund a study to determine how 
pervasive the disease has become in Canada.

Dr. Andrew Simor, head of microbiology at Sunnybrook and Women's College 
Health Sciences Centre, said the Toronto hospital is among about 20 or 
25 across the country that will be taking part in the study beginning 
this fall.

A surveillance of C. difficile in 20 Canadian hospitals was done in 
1997, said Dr. Simor, an infectious disease specialist. “But in view of 
the recent reports from Quebec and Montreal, as well as from other parts 
of the world, of increasing Clostridium difficile infection rates and 
also what appears to be an increasing severity of the disease, we 
thought it would be very important to repeat our previous study to see 
if there has been a change and what parts of the country are involved.”

Besides the possibility of a more virulent strain, overuse of 
antibiotics in general and the two used specifically to treat C. 
difficile — metronidazole and vancomycin — may have contributed to 
strains that are also becoming drug-resistant, doctors say.

Until researchers can produce more effective treatments or a vaccine 
against the C. difficile toxin, the best strategy for controlling the 
disease in hospitals is strict infection-control measures — washing 
hands, using gloves and gowns, and maintaining sanitation — coupled with 
appropriate use of antibiotics, Dr. Simor said.

“I think all hospitals across the country need to be prepared for larger 
outbreaks caused by this organism and more severe disease,” he said. 
“One thing we've learned about the spread of infectious disease is that 
none of us live in a protected, isolated environment.

“So a problem that appears in another country in the world or in a 
certain part of Canada, it's likely to be on our own doorstep sooner or 
later.”
-- 
Megan Holbrook - megan () kapow com
Partner - Business Development
kapow, inc. (www.kapow.com) - website design and development

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