Putting the Spotlight On Superbug Infection – C Difficile

Despite knowing the gory, textbook details about c. difficile— its resistance to most antibiotics… its potentially deadly consequences— the first time I met someone who was severely affected by it, I was a little shocked.  Waiting for the bus, one day, I noticed a man in a very bad mood.  Making a visible effort to control his pain, he seemed to be suffering from one of the usual ailments that affect the elderly— such as arthritis or heart disease.  After striking up a brief conversation, though, he told me about his experience with c. difficile and how a single course of antibiotics changed his life forever. His story began in the early 2000s, when he developed a c. difficile superbug infection after being treated for pneumonia.  Pointing to the colostomy bag on his hip, he told me how he needed to have the majority of his large intestine removed to survive.  Despite all this, his biggest concern was trying to prevent the same thing from happening to others.  With over 14 000 c. difficile-related deaths in the US last year, it’s likely a sentiment that many people share.  Fortunately newer technologies may be able to help to shine the light on antibiotic resistant c. difficile.

With genetic sequencing becoming more cost-effective, our ability to trace the underlying genes involved in resistance, is improving—as is our ability to geographically pinpoint where superbugs come from.  Using whole genome mapping, which catalogues genes for an entire organism, English scientists have been able to trace the course of deadly, antibiotic resistant c. difficile, back to North America, for example— with two of the most deadly strains emerging from Pittsburgh and Montreal.  Interestingly, the genetic research also shows that the two strains developed resistance to first-line antibiotics independent of one another.  Using such detailed metrics, it’s not hard to imagine tracking and containing a deadly mutation before it becomes the next superbug.

Currently, c. difficile is a challenging illness for hospitals and long-term care facilities.  As well as being resistant to most antibiotics, its ability to form defensive spores even makes it particularly hard to kill with antiseptics, such as alcohol hand sanitizers.    In spore form, c. difficile has the ability to survive, dormant, for years—much like its unpopular cousins, tetanus and c. botulinum (the bacteria responsible for botulism).  With spores able to persist on surfaces for such long periods, it’s little wonder that the bacterium has become such a persistent problem.

C. difficile infection occupies a very specific niche, because it most often occurs after antibiotic treatment.  Built to survive, resistant strains take advantage of the loss of good intestinal bacteria and are able to multiply without competition from other species.  As the resistant c. difficile population increases—unchecked by first-line antibiotics— it secretes higher levels of bacterial toxins that directly damage intestinal walls.  For many, including the man I met, long-term disability, or even death, is a very real possibility.

Although the development of new classes of antibiotics may not be possible at the moment, increased tracking and identification of different strains may help prevent new mutations from spreading beyond their point of origin.

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