So many ways to die

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Montreal, Calgary hospitals battling outbreak

CTV.ca News Staff

 

An infection that has struck 1,400 patients in Montreal and Calgary hospitals has killed more people in Canada than SARS did, according to a report in the Canadian Medical Association Journal.

 

At least 79 people have died after being infected by Clostridium difficile, most of whom contracted the infection in 2003 or early 2004.

 

By comparison, SARS killed 44 people in just over a five-month period.

 

Some victims are young, but most are elderly.

 

Isabelle Roche's 80-year-old mother was one victim. After getting a cyst removed from her liver, she developed serious diarrhea and died.

 

"Very quick. Within hours she was getting sick. Five weeks after going into hospital she died," Roche said.

 

The journal article blames the outbreak on an overuse of proton pump inhibitors, a popular antacid medication used to treat ulcers and gastro-esophageal reflux disease.

 

"It's believed that the medication, in lowering the acid levels, fights off that first level of defence, which in essence is sterilizing the gut and sterilizing the bacteria that is present," said CTV medical consultant Dr. Marla Shapiro.

 

"These two factors together increase the likelihood that the organism would take over," she said.

 

Patients taking antibiotics are also vulnerable because the drugs cause a change in the normal bowel flora, allowing permitting the C. difficile organism to thrive and produce toxins.

 

Shapiro told CTV Newsnet why information on the organism is only being heard now.

 

"This is the first time that a retrospective study has gone on examining this particular issue, looking at do these deaths have anything in common, is there an identifiable risk factor," she said.

 

Dr. Sandra Dial, a Montreal physician, noticed the problem about 18 months ago.

 

"Patients were coming in very, very ill, with low blood pressure, needing ICU to keep them alive. And quite a few of those patients have died," she said.

 

"We're dealing with a more virulent strain in an environment where it is really appropriate for this virulent strain to spread quickly," said Dr. Karl Weiss of Maisonneuve-Rosemont Hospital in Montreal.

 

Some 1,400 patients in six Montreal hospitals have tested positive for C. difficile, and at least six other hospitals in the city are also battling outbreaks.

 

C. difficile is resistant to most broad-spectrum antibiotics and is the most common cause of infectious diarrhea in the industrialized world.

 

Research suggests 20 per cent of people who contract it get after taking antibiotics.

 

Unlike SARS, however, Shapiro said there's no need to fear that C. difficile will escape from hospitals and infect the general population.

 

"We're looking at a group of individuals in hospital on multiple-use antibiotics which we know is an existing risk factor ... plus proton pump inhibitors," she said.

 

Dr. John Carsley, head of the infectious disease unit of the Montreal public health department, told The Canadian Press that comparisons to SARS were "inappropriate," and refused to blame the outbreak on overcrowding in hospitals.

 

"If anything, over the past year or so infection-control measures have become even more strict with all the concern about transmission of SARS," he said.

 

"I think that has an overall effect on how careful people are and how rigorous they are in following infection-control measures."

 

According to Dial of the Montreal Chest Institute, patients taking proton pump inhibitors are twice as likely to contract C. difficile.

 

Dial also said C. difficile was more prevalent in Montreal and Calgary because proton pump inhibitors are widely used in Quebec and Alberta hospitals.

 

She suggested patients at risk of C. difficile switch to milder antacids if possible.

 

The outbreak is not yet under control in either Montreal or in Calgary, where hospitals are trying to contain a less virulent strain that resurfaced following an earlier outbreak in 2000 and 2001.

 

Calgary officials say they're "alarmed" by the latest outbreak and are recording about 10 new cases of C. difficile per month at each of the city's three main hospitals. The normal rate is between three and five new cases per month.

 

CTV's Jed Kahane said despite the deaths, the epidemic had been kept quite.

 

"Hospitals say they didn't want people to panic. But some doctors disagree with the silence," he said.

 

"They say patients should have been warned so they'd at least have the choice of cancelling elective surgery, if they consider the risk too high," he said.

 

With a report from CTV's Jed Kahane