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Here's another one to add to the tally of drawbacks of life-saving antibiotics: according to a recent article in the American Journal of Infection Control, the burden of Clostridium difficile (C. diff) in US health settings is significantly higher than previously estimated. "Thirteen in every 1,000 inpatients has C. diff -- 20 times more than previous estimates" (see attached image for variance in prevelence by state).

For those wondering about the connection between C. diff and antibiotic use, the answer is collateral damage--Though antibiotics can cure susceptible bacterial infections, they do so at a cost to commensal flora.

Dr. Lou Rice explains:

Our anthropocentric view of the universe generally specifies as human those cells that contain human DNA. A broader view of our existence would acknowledge that we also consist of a multitude of cells that do not contain human DNA—our abundant "colonizing" microflora. In a sense, this microflora is yet another organ whose proper functioning is essential to our well-being. Among other functions, bacteria participate in our enteropathic circulation, as well as helping to break down oligosaccharides in the colon as fatty acids. Unfortunately, just as our properly functioning organs are sometimes the source of deadly cancer, our microflora is occasionally the source of the bacteria that cause serious infection. Antimicrobial agents do not distinguish colonizing from infecting flora; they simply inhibit or kill any susceptible microbe with which they come in contact. In short, it is rarely possible to successfully treat an infecting bacterium without also doing significant "collateral damage" to our friendly microflora.

When this friendly microflora is compromised by treatment with an antibiotic it allows opportunistic C. diff to explode in numbers. People infected with C. diff suffer from stomach cramps, profuse diarrhea, and inflammation of the intestine. In some cases, when the infection is resistant to antibiotics and cannot be stopped, doctors must remove a section of the colon.

According to the New York Times, health officials estimate that in the United States C. diff causes 350,000 infections each year in hospitals alone, and kills an estimated 15,000 to 20,000 people annually. "The public health community has been sounding the alarm for years about the overuse of antibiotics and the emergence of “superbugs” — bacteria that have developed immunity to a wide number of antibiotics. But the C. difficile problem shows that the threat is not generalized or hypothetical, but immediate and personal."

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C. diff prevelence.pdf132.64 KB