Probiotics prevent C. Difficile in a hospital setting

Clostridium difficile infection has recently become a major issue in Ontario hospitals. Outbreaks were declared in May of this year in several hospitals around the province and C. difficile is already responsible for the deaths of 26 Ontarians.

C. difficile is a bacteria that is spread by people who have been in contact with contaminated surfaces and spread it to susceptible patients. But not all hospital patients are likely to become infected with the bacteria. Infection occurs almost exclusively in patients who are taking antibiotics that kill the good intestinal bacteria, allowing C difficile to grow.

Thats right…C difficile is what is known as an opportunistic pathogen. That means that it can only set up shop and cause an infection when the conditions are just right and a healthy intestinal flora prevents C difficile from being able to do so. But antibiotics, and especially broad spectrum antibiotics, wipe the slate clean in your intestines creating the ideal environment for C difficile infection.

A recent meta-analysis in the Journal of the American Academy of Nurse Practitioners is the latest addition to the growing body of evidence demonstrating the usefulness of probiotics to prevent C. Difficile infections in a hospital setting.

This study reports that the concurrent use of probiotics and antibiotics decreases the risk of C difficile associated diarrhea by a whopping 71%!  This number may sound incredible, but it shouldn’t really come as much of a surprise given that these infections are virtually non-existent in people with a healthy gut flora.

But how do probiotics prevent infection? There are 2 main mechanisms.

First, probiotics prevent the invading bacteria from attaching itself to the walls of your intestines. They do this by out-competing a potentially pathogenic bacteria for nutrients, thereby limiting their ability to grow and thrive. Also good bacteria produce chemicals that are directly toxic to invaders, called bacteriocins and defensins.

Second, probiotics beef up your own natural lines of defence, improving the function of your intestinal barrier. When this defensive barrier is healthy and intact, it makes its own protective molecules (called cytokines) that help your immune system to fight off any nasty would-be invaders.

The value of having abundant, healthy intestinal bacteria is only starting to be understood by medical science, but already it is clear that its importance cannot be understated.

When it comes to C Difficile, we are not only considering the toll on the infected patients. C difficile is a huge financial burden on the province as well as on the health care system in general. One study estimates that each case of C difficile costs the province an extra $2500 in treatment costs. Compare that to a course of probiotic therapy at the cost of less than $100. You don’t have to be Dwight Duncan to figure out that probiotic therapy could be saving taxpayers a ton of money. And of course every patient infected means a longer hospital stay, taking up a bed in our already crowded hospitals.

Here in Ontario, the Ministry of Health and Long Term Care released official guidelines on how to help control the outbreak. The document states that infection should be controlled by a regimen of meticulous hand washing, frequent cleaning of the patient environment and using narrow spectrum antibiotics whenever possible. Probiotics are not mentioned once in the 43 page report.

To completely ignore a preventive treatment option that has the potential to so drastically reduce rates of infection in a cost effective manner is short-sighted and misguided, in my opinion.

Its about time that we get serious about preventive medicine in Ontario and incorporating the use of probiotics along side antibiotics into hospital treatment plans. This is no longer “alternative” medicine, it’s just smart medicine.