Different Drug Would Save More Lives, Study Shows


Dr. Vanessa Stevens smiles in the Healing Ground at the VA Salt Lake City on Wednesday, Feb. 17, 2017. (Rishi Deka, Daily Utah Chronicle)

By Elise Vandersteen Bailey, Investigative Coordinator

Nausea, fever, weight loss, rapid heart rate, diarrhea ten to fifteen times a day, and kidney failure. These are just some of the symptoms of a severe infection from a small bacterium called Clostridium difficile—nicknamed C. diff.

According to a new study by University of Utah assistant research professor, Vanessa Stevens, C. diff  “is a ubiquitous bacterium, which means that you can find it everywhere, including in the soil.”

It’s also one of the most common infections that can be acquired inside a hospital.

The Mayo Clinic says the infection is “passed in feces and spread to food, surfaces and objects”, and explains that the bacteria can “persist in a room for weeks or months”.

Hospitals provide both a higher likelihood of the bacteria being on a given surface and a “high concentration of susceptible people clustered together” because “people who are in the hospital tend to have lowered immune defenses.” said Stevens.

This spread of the bacteria could be due to patients, visitors, or even healthcare providers failing to wash their hands.

According to the CDC, some doctors may need to wash their hands up to 100 times in a 12-hour shift, depending on their area of practice. They also say studies show some doctors wash their hands “less than half of the times they should” and that wearing medical gloves is not a substitute for washing hands.

The VA infectious diseases research team (left to right), Dr. Karim Khader, Dr. Vanessa Stevens, Dr. Matt Samore, Dr. Lindsay Croft, Dr. Rich Nelson, and Dr. Mike Rubin, smile in the Healing Ground at the VA Salt Lake City on Wednesday, Feb. 15, 2017. (Rishi Deka, Daily Utah Chronicle)

C. diff. infection is also likely to recur, even after a patient completes treatment. Stevens says this is due either to a “reactivation of a previous infection that was not properly cured” or “acquiring the infection again” which could happen because “people are still at risk—they are still receiving antibiotics, are still immune suppressed, and possibly are still contacting the health care system.”

Typically, C. diff. infection is treated by ingestion of a drug called metronidazole, which works because it can damage the DNA of the bacteria. However, Stevens and a group of other researchers used data from over 10,000 patients—treated for C. diff. infection through the VA’s healthcare system between 2005 and 2012—and found that fewer patients with severe infection died when treated with ingestion of another drug already available for use: vancomycin.

In fact, they found it would only require switching treatment of 25 patients from metronidazole to vancomycin to prevent a death.

Vancomycin works by preventing the bacteria from properly producing cell walls, their protection from the outside environment, and essentially stops the ability of a colony of bacteria to reproduce.

Stevens says they aren’t yet sure why vancomycin would treat severe cases of the infection better than metronidazole, but says “it’s possibly related to the concentration of the drug at the site of infection [like the intestines].”

The researcher added, “Oral vancomycin can’t be absorbed from the gut into the blood stream, so the full concentration remains where the infection is. Metronidazole, on the other hand, is readily absorbed from the intestine into the blood stream, leaving a smaller concentration in the intestine to actually fight the infection.”

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