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Fábregas: Think twice about antibiotics — they enable killer superbug

Luis Fábregas
| Saturday, March 7, 2015, 12:01 a.m.
This 2004 electron microscope image made available by the Centers for Disease Control and Prevention shows a cluster of Clostridium difficile bacteria. The intestinal bug sickens nearly twice as many Americans each year as was previously thought, according to a study released by the Centers for Disease Control and Prevention on Wednesday, Feb. 25, 2015.
This 2004 electron microscope image made available by the Centers for Disease Control and Prevention shows a cluster of Clostridium difficile bacteria. The intestinal bug sickens nearly twice as many Americans each year as was previously thought, according to a study released by the Centers for Disease Control and Prevention on Wednesday, Feb. 25, 2015.

The latest national priority has nothing to do with terrorism, uninsured people or the federal budget.

It's a deadly superbug called Clostridium difficile — or C. diff, for short — that infects half a million people a year and is particularly harmful to older folks.

A new study published in The New England Journal of Medicine linked the nasty bug to 29,000 deaths in a single year. About 15,000 of those deaths were directly attributable to the infection, while the rest had other contributing factors. More than 80 percent of those who died were Americans 65 or older.

The problem is getting so out of hand that the Centers for Disease Control and Prevention says reducing the infections is a national priority. The bug causes inflammation of the colon, stabbing pain in the gut and deadly diarrhea.

There's more reason to worry.

C. diff infections traditionally have been found in hospitalized patients. This study shows something new. About 150,000 of the infections, or about 30 percent, were people who picked up the infection outside the hospital, either in a doctor's office or at the dentist.

Not to gross you out, but this bug has been found on patient chairs and examining tables in outpatient settings. This is similar to the better-known staph infection MRSA, which is found in schools, day cares and locker rooms. As Dr. Amesh Adalja told me, C. diff is no longer limited to the hospital setting.

“It's not that everybody who goes to see the doctor is going to get C. diff. It's just that these pathogens don't care where they infect you,” said Adalja, an infectious disease physician at the UPMC Center for Health Security.

You can blame our constant misuse of antibiotics.

When a person takes antibiotics, often for a viral infection that won't respond to the drugs, they're wiping out beneficial bacteria that we need to protect against infection. As Adalja puts it, antibiotics allow C. diff to get a foothold without competition because, well, antibiotics have wiped out their competition.

In many ways, we have only ourselves to blame for the problem. We visit the doctor's office to address an upper respiratory problem, say a cough or a stuffy nose, and we expect the doctor to give us some type of medicine before we walk out the door. We pay for a doctor's visit, so we expect something in return. It's that simple.

But experts estimate that more than half of antibiotics are prescribed unnecessarily in outpatient settings. Some studies proved that scaling back the use of antibiotics in hospitals has been linked to drops in C. diff infections.

You've probably heard about someone who suffered from this infection. Doctors say it's difficult to treat, and those who have it face a daunting recovery — if they recover at all.

On top of that, it's a very costly infection. The CDC says it can rack up about $4.8 billion in health care costs every year.

There are several treatments in the pipeline, including experimental fecal transplants. In the procedure, patients receive healthy feces from a donor, typically by colonoscopy or a tube in the nose, Adalja said. The treatment has been successful, but it's not yet widely used. Even if it's adopted, it still doesn't fix the problem of antibiotics disrupting a person's healthy bacteria. And, quite frankly, it just doesn't sound appealing. The best way to avoid it might simply be to get smarter about using antibiotics.

Luis Fábregas is Trib Total Media's medical editor. He can be reached at 412-320-7998 or lf abregas@tribweb.com.

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