March 14, 2019

UCalgary researchers partner with AHS to tackle dangerous bug in hospitals

Early indications are probiotics may be an effective tool to prevent illness from C. difficile

Cases of Clostridium difficile infection, often called C. diff, the most common cause of hospital-associated diarrhea, appear to be down about 30 per cent as part of a new strategy at Calgary adult acute care hospitals.

University of Calgary researchers and Alberta Health Services (AHS) are providing patients with probiotics in an effort to prevent the sometimes-deadly but often serious infection. C. diff bacteria are abundant in nature and may be resistant to antibiotics and certain disinfectants. Spores can survive for months on hospital surfaces, despite exhaustive measures to keep them in check.

As part of a three-year initiative being conducted through the W21C (Ward of the 21st Century) and co-led by Dr. John Conly, MD, an infectious disease specialist and member of both the O’Brien Institute for Public Health and the Snyder Institute for Chronic Diseases at the Cumming School of Medicine and pictured above, it is expected tens of thousands of Calgary hospital patients will participate in the program. Candidates are men and women aged 55 and older who have received a prescription for antibiotics. Patients must have a functioning bowel, are not receiving cancer chemotherapy and do not have compromised immune systems. Those who qualify receive Bio K+, a Canadian-made probiotic recognized by Health Canada for prevention of diarrhea from antibiotics. The initiative is now underway at South Health Campus, Rockyview General Hospital, Peter Lougheed Centre and Foothills Medical Centre. 

“The early results are promising and indicate probiotics may be effective in preventing C. diff,” says Conly, who is a professor in the departments of medicinepathology and laboratory medicine, and microbiology, immunology and infectious diseases at the CSM. “The theory is, by improving overall gut health the body can ward off the onset of C. diff, which is a spore-forming bug that causes severe diarrhea and inflammation of the colon.”
 
How a diagnosis of C. diff affects your life

Bruce Dalton, an infectious diseases pharmacist with AHS and member of the O’Brien Institute, says many people suffer for years with C. diff. “It’s more than just uncomfortable, it can inflame the colon to the point where the colon can leak, which leads to sepsis and even death.” 

Since 2011, Alberta Health Services Infection Prevention and Control has attributed over 500 deaths to C. diff. 

Michelle Myers, 61, underwent a fecal transplant last July to try to end the suffering she was experiencing. Fecal transplants restore compromised colonic microflora by introducing fecal bacteria from a healthy individual. The transplants are considered to be a last resort to treating this disease.

“I had never heard of C. diff until I acquired it in 2014 after a bone marrow transplant to treat lymphoma,” she says. “The infection disappeared after treatment but returned in 2017 when I was admitted to hospital for another bone marrow transplant."

Myers experienced numerous treatments and hospital visits to replenish the fluids robbed by infection. “It made my life really, really difficult. I was unable to do the things I enjoy — I was basically tied to a bathroom,” Myers says. “My life has returned to normal after the fecal transplant. I can be active again and enjoy dinner out with friends. Prior to the transplant, I didn’t go anywhere because I was afraid I might have an accident and make a spectacle.”

Dalton adds some people will have 12, 18 or even 20 reoccurrences. “It comes to the point where the most effective therapy, as Michelle discovered, is a fecal transplant,” he says. 

The financial impact of C. diff is enormous 

Along with being devastating for the people who have it, C. diff infections are an enormous burden on health systems. Patients require isolation, consultations by gastroenterologists and infectious disease specialists, and longer hospital stays. 

Canada saw almost 38,000 cases of C. diff infection in 2012, the majority of which were hospital-acquired, according to research published in 2015 that pegged the nationwide cost in care and lost productivity at $281 million.

Alberta sees over 1,000 cases of hospital-acquired C. diff every year, a number this team hopes to lower. “Even if we don’t eliminate all cases of C. diff, by reducing the numbers we can reduce the chance of another patient contracting it,” says Conly, who is also the medical director of W21C in the O’Brien Institute.

The initial phase of the initiative ends this fall. Conly says if the preliminary results hold up, the use of probiotics in all AHS acute care facilities may be considered as a strategy to reduce C. diff.

The initiative is funded by Alberta Innovates, in partnership with AHS. Conly’s co-leads on this project are Drs. Thomas Louie and Jayna Holroyd-Leduc.

Dr. Holroyd-Leduc, MD, is professor in the departments of medicine and community health sciences and a member of the Hotchkiss Brain Institute and O’Brien Institute for Public Health.

Dr. Louie, MD, is a clinical professor in the departments of medicine and microbiology, immunology and infectious diseases at the Cumming School of Medicine. He is also professor emeritus and member of the Snyder Institute for Chronic Diseases