[at-l] Before you think you're safe with Purel.....

[sloetoe at yahoo.com (Sloetoe)]

Just to restate, hygienic habits will do you aLOT more good than
a gallon of Purel.....

lightenuptoe
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New intestinal bug emerging in North America
 1 hour, 51 minutes ago
 


Two reports highlight the emergence of a new, highly toxic
strain of the bacterium Clostridium difficile that is resistant
to fluoroquinolone antibiotics, such as Cipro (ciprofloxacin)
and Levaquin (levofloxacin), and is causing geographically
dispersed outbreaks.

The reports were released early by The New England Journal of
Medicine to coincide with this week's report by the Centers for
Disease Control and Prevention C. difficile infections in
low-risk patients.

C. difficile is a microbe that can be a member of the normal
bacterial colonies that live in the intestines. Problems occur,
however, when neighboring bacteria are disturbed allowing an
overgrowth of C. difficile, which typically results in a
foul-smelling watery diarrhea. Overuse of certain antibiotics is
one common cause of such disturbances.

The CDC has received an increased number of reports from health
care facilities of cases of severe C. difficile-associated
disease, according to one of the papers. Dr. L. Clifford
McDonald, from the CDC in Atlanta, and colleagues say this
suggests the emergence of an epidemic strain with increased
virulence, antibiotic resistance, or both.

To test this hypothesis, the research team collected 187 C.
difficile samples from outbreaks since 2001 in eight health care
facilities in six states, and compared their characteristics
with those of 6000 samples obtained between 1984 and 1990.

More than half of the recent samples were of one strain, termed
BI/NAP1. Testing showed that this strain was particularly
resistant to fluoroquinolone antibiotics.

By contrast, just 14 of the 6000 isolates obtained in the past
were of this strain, the report indicates.

"If this epidemic strain continues to spread and to contribute
to increased (disease and death), it will be important either to
reconsider the use of fluoroquinolones or to develop other
innovative measures for controlling C. difficile-associated
disease," McDonald's group writes.

They stress the need for strict infection-control measures.
Because alcohol does not kill C. difficile spores, they
recommend that health care workers wash their hands with soap
and water instead of using alcohol-based hand sanitizers during
outbreaks.

According to a second report, Canadian researchers, led by Dr.
Vivian G. Loo from McGill University Health Center in Montreal,
identified 1719 episodes of C. difficile-associated diarrhea at
12 Quebec hospitals between January and June of 2004.

>From 1997 to 2004, the rate of infections increased from 6 to
22.5 cases per 1000 admissions. Moreover, in 2004, nearly 7
percent of patients with this infection died within 30 days
compared with 1.5 percent in 1997.

The predominant strain was similar to that observed by
McDonald's group and was resistant to ciprofloxacin,
moxifloxacin, gatifloxacin and levofloxacin.

Loo's team conducted a study comparing 237 patients with C.
difficile-associated diarrhea with 237 patients outcome this
problem. They found that treatment with cephalosporin
antibiotics or fluoroquinolones increased the risk of this
diarrhea by nearly fourfold each.

In an editorial accompanying the two papers, Drs. John G.
Bartlett and Trish M. Perl, from Johns Hopkins University School
of Medicine in Baltimore, point out that standard stool tests
will not identify this epidemic strain.

They therefore advise that "physicians and infection-control
personnel need to monitor for an increasing (rate) of C.
difficile-associated disease on the basis of some classic
features" in patients who have recently been treated with
antibiotics.

SOURCE: The New England Journal of Medicine, December 8, 2005.