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How to fight a difficult, hardy bacteria.

Byline: YOUR HEALTH By Cathy Stone For The Register-Guard

For many years antibiotics have been used to treat bacterial infections. With a person's healthy immune system and properly prescribed antibiotics, bacterial infections can be successfully treated.

Unfortunately, bacteria can survive by adapting to the environment.

This means common bacteria become resistant to common antibiotics by mutating. These cellular mutations have resulted in organisms resistant to multiple drugs, such as methicillin resistant Staph aureus, known as MRSA, and vancomycin resistant enterococcus, commonly called VRE.

Another concern with antibiotic treatment is that sometimes the antibiotic destroys or decreases the level of "good" and necessary bacteria. This allows usually harmless bacteria in the body to multiply.

In the case of toxin-producing Clostridium difficile (C. difficile), which resides in the digestive tract, you may become quite ill. For antibiotics to cause C. difficile-associated disease, you must be exposed to the C. difficile organisms, or already have it in your intestinal tract - 3 percent of adults carry it in their intestinal tract.

C. difficile is transmitted by ingesting the bacteria. Nationally, most people come into contact with C. difficile during hospitalization, although there are some community-acquired cases now being recognized.

There are two forms of this bacteria: an active, infectious form that produces toxins and cannot survive in the environment for prolonged periods, and a nonactive form, called a spore. Spores cannot cause infection directly, but when ingested they transform into the active, infectious form. Spores can live for years in the environment.

Mild C. difficile colitis symptoms include a low-grade fever, watery diarrhea, mild abdominal cramps and tenderness. Severe C. difficile colitis symptoms include a high fever, severe watery diarrhea (more than 10 watery stools a day) and severe abdominal pain and tenderness.

A more aggressive strain of C. difficile - the NAP1 strain - recently was identified in Lane County. This virulent strain of bacteria causes severe C. difficile-associated disease.

Such severe cases can lead to dehydration and disturbances in electrolytes in the body and to life-threatening complications such as sepsis, megacolon, peritonitis and perforation of the colon. In some cases, people have died because of severe C. difficile disease.

Treatment includes discontinuing the antibiotic that caused the symptoms. In mild cases, this may be enough for the diarrhea to subside. In most cases, however, antibiotics are needed to eradicate the C. difficile bacteria.

The only antibiotics that are effective against C. difficile include metronidazole (Flagyl) and vancomycin.

Other strategies include supplementing your diet with nonpathogenic yeast by mouth such as Saccharomyces cerevisia, which is found in brewer's yeast, or Lactobacillus acidophilus found in yogurt.

Approximately 20 percent of successfully treated patients can experience a relapse with recurrence of diarrhea, abdominal cramps and pain. As with other bacteria, antibiotic resistance is now being recognized in C. difficile.

In fact, C. difficile is a very hardy bacteria. Alcohol hand gel, a common form of hygiene, is not active against C. difficile. Soap and water is the only way to wash the organism off your skin.

In regard to C. difficile environmental contamination: Theoretically, the inactive spore form can be killed only with a diluted bleach concentration. In the vegetative state, the bacteria can be killed with other disinfectants.

What can you do to prevent the spread of C. difficile? Your best strategy if you think you have C. difficile disease, is to see your health care provider for appropriate testing and treatment. Then along with any medically prescribed treatments, diligently practice healthy hygiene:

Wash your hands with soap and water, especially after using the restroom and before eating.

Frequently clean surfaces in bathrooms, kitchens and other areas with detergents and disinfectants.

If cleaning cannot be done frequently, clean those areas with diluted bleach.

These habits will go a long way toward preventing C. difficile infection, as well as helping to overcome illness due to this bacteria and avoid its further spread.

Cathy Stone is an infection preventionist at McKenzie- Willamette Medical Center.
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Title Annotation:Springfield Extra
Publication:The Register-Guard (Eugene, OR)
Date:Jan 22, 2009
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