The person who came up with the term antibiotic was way ahead of the times.
In its root form it means “against life”, with “anti” meaning against and “bios” meaning life.
In their infancy, antibiotics were the new shiny wonder toy that would cure everything and they were liberally — too liberally — prescribed.
Now many bacteria have become resistant to the drugs and have mutated to create bigger and better bugs, which are a serious problem in hospitals where controlling infections is a constant battle.
This week’s events at Trillium Health Centre remind us that antibiotics can be literally, against life, in that they can hasten the onset of bacteria like C.difficile that can attack a vulnerable person and kill them.
The headlines, of course, make it sound like Clostridum difficile dropped out of the blue and grew overnight into a full-blown, out-of-control crisis that quickly took the lives of four patients.
As I learned from talking yesterday to Trillium Director of Infection Prevention and Control Dr. Kystyna Ostrowska, things are a lot more complicated than they may first appear.
C.difficile has been in hospitals for decades and comes in many different forms, most of which are relatively benign, even to the sick.
To maintain a good balance of bacteria in your gut, you should have about 15 per cent bad bacteria and 85 per cent good bacteria.
When elderly people with multiple medical conditions need cardiac surgery or cancer surgery or treatment for some other serious condition, the doctors have no choice but to give them antibiotics to fight post-operative infection. While doing that necessary thing, they must balance the probability that killing much of the good bacteria in the intestines in the process will make them much more vulnerable to the bad guys.
C.difficile is naturally present in about four per cent of the population. That doesn’t seem like much but once the bacteria becomes active causing serious diarrhea, it can spread very easily.
A patient can come into the hospital with it, or can acquire it once in the hospital very easily. Determining when it was actually acquired is a highly problematic business and probably not that fruitful an exercise, despite the fact everyone wants to know exactly how it started.
This new Québec strain of the disease is much more virulent. Although it is likely no threat to anyone in generally good health, it is certainly a danger to those who are very elderly, suffer from numerous medical conditions, have been on antibiotics for prolonged periods and are in hospital or institutions.
Dr. Ostrowska said that the importance of the protocol to treat these patients (gloves and gowns and the full rigmarole) has been stressed and re-stressed to all hospital staff. “Individual staff responsibility and what you do when you care for patients is very important,” she said. “In the post-SARS era, staff is much more aware of their part in a team effort and they think in terms of what I can do for my patients.”
Isn’t it interesting that when all is said and done, the best line of defence against C.difficile and so many other medical threats is still soap and water, properly applied with lots and lots of elbow grease.
In passing, Dr. Ostrowska mentioned other outcomes of the C.difficile problem that don’t immediately come to mind. One is that there is a limit on the number of private rooms at any hospital and eventually you are using rooms that were intended for more than one patient. When that happens, it causes a backup in the whole system.
Patients must wait longer to be admitted and the spillover can mean problems elsewhere in the hospital, such as the emergency room.
Outbreaks like the one at Trillium are likely to become more common in future. “As the years go by, the patient population is getting older and they come in sicker and they are dealt with much more aggressively medically, and surgically,” explained Ostrowska, a Mississauga resident. That can mean they are also more vulnerable to post-operative infections like C. difficile
Yet another good reason to support community-based support services that allow people to stay as healthy as possible as long as possible in the comfort of their own homes.