Checks stepped up as deadly strain of C. difficile emerges in US and Europe
SINGAPORE is preparing for a killer bug that could head this way, as hospitals step up checks on the more susceptible patients – those on antibiotics and the elderly. The immediate symptom is diarrhoea. All patients suffering from diarrhoea and who are on antibiotics are undergoing checks. Doctors in public hospitals want to be certain that such patients are not infected with the killer strain of the Clostridium difficile bacterium called the ribotype 027.
The strain wreaked havoc in about 30 hospitals in Quebec province in Canada in 2003 and 2004, infecting more than 1,400 patients. Many needed urgent surgery and about 14 per cent died within a month of diagnosis. Several hospitals in the United States were also affected. The bug has since crossed the Atlantic and has emerged in hospitals in Britain, Ireland and Denmark over the past two years.
Doctors fear that it is only a matter of time before it finds its way to Asia. The bacterium, commonly known as C. difficile, has been around for a long time, and is a common hospital-acquired bug. It is only the ribotype 027 that has proven deadly, even though the normal version can also sometimes be fatal. People on antibiotics could get the bug because such medication disrupts the good bacteria in their bodies, which would normally keep the dormant Clostridium difficile spores from turning infectious. The elderly with multiple medical problems could also be susceptible.
In July, the Ministry of Health (MOH) invited Dr Clifford McDonald, who heads prevention and response in the Centres for Disease Control and Prevention (CDC) in the United States, “to discuss how to improve surveillance and prevention measures for C. difficile”. He came as part of the ministry’s programme for visiting experts, where they spend about a week sharing their expertise with the medical fraternity.
An MOH spokesman said: “Following discussions with Dr McDonald, public hospitals have taken steps to enhance their antibiotic stewardship programmes to reduce risks.” Dr Chris Willis, chairman of infection control at Khoo Teck Puat Hospital, warned that the virulent strain could be “catastrophic” if it spread within a hospital. It is relatively easy for that to happen as such patients tend to have severe diarrhoea, leaving those who come into contact with them vulnerable. He was working in Canada when the bug caused an epidemic in Quebec. Surgeons there worked furiously to save lives by removing part of the patients’ infected colons.
Dr Willis said the 027 spores are difficult to get rid of as they are not killed by alcohol. Hospitals use a solution with 10 per cent bleach to kill them. In its milder form, C. difficile causes diarrhoea, fever and nausea. In more serious cases, patients can get colitis, or inflammation of the large intestine. Dr Willis said: “It would make MRSA (Methicillin-resistant Staphylococcus aureus, also known as the superbug) look like a picnic.”
Dr Lim Poh Lian, a senior infectious diseases consultant at Tan Tock Seng Hospital, which houses the Communicable Disease Centre, said it has improved its laboratory testing of C. difficile. It gets up to 15 patients with this infection each month. The hospital actively tests patients. If they have bugs that are resistant to antibiotics, they are either placed in isolation or with others suffering similar infections. In a paper two years ago, Dr Lim recalled a fourfold rise in C. difficile among hospital patients in Singapore between 2001 and 2006. She had urged hospitals then to “heighten vigilance for the introduction of outbreak strains (such as the 027) into Asia”.
Regular hand-washing, the testing of patients and reduced use of antibiotics have helped to cut C. difficile rates at the hospitals by 30 to 50 per cent, she said. C. difficile-related diseases cost the US an estimated US$3.2 billion (S$4.2 billion) a year, due to longer hospital stays. Dr Lim said that on average, even patients with the milder strains stayed in hospital five days longer.