NY Times — Jacob Epstein, a healthy 88-year old resident of Florida, died in May following a fracture of his arm. He was given an antibiotic in the hospital after his procedure which led to an intestinal infection that caused his death. The antibiotics given by the hospital interrupted the balance of bacteria in the gut, leading to an increase of Clostridium difficle, or C. diff., an antibiotic-resistant strain that causes 30,000 deaths a year in the United States alone. The spores of C. diff. are resistant to heat, acid, and antibiotics, and although they are inhibited with soap and water, alcohol-based hand sanitizers that are widely used in healthcare facilities are not effective in removing the spores. Normally micro-organisms that reside in the gut prevent the growth of C. diff., but antibiotics can throw off the balance, leading to a dangerous infection. The severity of an infection with C. difficile, as well as recurrences, increases with age. Multiple approaches to treating C. difficile are being considered, with none successfully in place yet.
We talk a lot about the microbiome of the gut these days. We think of it as an ecosystem of trillions of good and bad bacteria that have adapted to exist in harmony with each individual. Research suggests that the human microbiome may have a significant role in the immune system and the overall health of the individual. When antibiotics are taken, in killing the offending bacteria causing the infection they are treating, they are also disrupting the delicate balance of organisms within our microbiomes. Clostridium difficile (C. diff) is a bacterium that then overgrows and attacks the lining of the intestines, causing severe diarrhea that can become life threatening. There have been a number of studies suggesting that probiotics are both safe and effective in preventing C. diff-associated diarrhea, as well as reducing post-surgery infections after abdominal surgery, a risk factor for C. diff. Unfortunately, although taking probiotics would seem like a simple and benign thing to do, this preventive measure against C. diff infections has not become an accepted intervention in medicine. However, during consultations with my patients, this is always an issue we discuss together, whether around health maintenance, risk factors affecting the health of the gut, or serious medical illnesses.