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	va1-sg19016.securesites.net

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CLOSTRIDIUM DIFFICILE - UNITED KINGDOM (ENGLAND)

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[A war veteran] who survived 3 years as a prisoner of war died after 

catching _Clostridium difficile_ following an operation.   [The 

88-year-old] was admitted to hospital after slipping on the floor at 

home and fracturing his femur.  [He] had surgery at Gloucestershire 

Royal Hospital but he developed an infection and was given a course 

of antibiotics. Weeks later he died and an inquest was told the 

medicine had left him more vulnerable to catching the superbug.



The coroner told the inquest hearing in Gloucester that [the Major] 

probably would not have died if he had not been given the drugs 

following the operation. The inquest heard how the medicine can alter 

bacteria in the bowel, making vulnerable patients more susceptible to 

contracting [_C. difficile_]. Surgeon Nadir Kalap said [the patient] 

was given a 7-day course of antibiotics to combat low blood pressure 

and signs of an infection.



A post-mortem examination by pathologist Dr John McCarthy revealed 

the primary cause of death was [_C. difficile_] with heart disease a 

antibiotics are at most risk of developing [_C. 

difficile_]."  Summing up the case, Gloucestershire coroner Alan 

Crickmore said [the patient] would not have contracted the disease 

had he not had the antibiotics.



A spokesman for Gloucestershire Hospitals NHS [National health 

Service] Foundation Trust said it had been working hard over the past 

year to reduce rates of infection. "We have been successful in our 

efforts and infection rates have fallen considerably," he said. 

"However, we are not complacent and will continue to implement our 

wide-ranging action plan."



Almost 56 000 vulnerable and elderly patients have been infected with 

[_C. difficile_] in the past year. Between January and March [2007] 

alone, 15 592 caught the bug -- an astonishing 22 per cent rise on 

the previous 3 months. [_C. difficile_], which is spread by dirty 

hands and bedding, is a bigger killer than MRSA 

[methicillin-resistant _Staphylococcus aureus_]. It claimed 2247 

lives in 2005 -- a 69 per cent rise on the previous year [2004]. It 

exists naturally in the stomachs [intestines] of many healthy adults, 

where it is kept under control by 'friendly' bacteria. Problems start 

if the balance of bacteria is disturbed, perhaps as a result of 

taking antibiotics for another infection.  Once the "friendly" 

bacteria are killed off, the [_C. difficile_] is able to multiply and 

produce the toxins which cause diarrhoea and, in the worst cases, a 

fatal infection of the abdomen.



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[Recent outbreaks of _Clostridium difficile_-associated diarrhea with 

increased severity, high relapse rate and significant mortality, have 

been related to the emergence of a new, hypervirulent _C. difficile_ 

strain in North America, Japan, and Europe. The emerging strain, 

which hyper-produces toxins A and B, is referred to as North American 

pulsed-field type 1 and polymerase chain reaction [PCR] ribotype 027. 

It is not stated whether the patient in the news release above was 

infected with ribotype 027, which has spread extensively in the UK 



Control of spread of _C. difficile_ in healthcare facilities involves 

aggressive infection control measures and restraint in the use of 

antimicrobial agents. However, it seems the patient described in the 

news release above received appropriate antibiotic therapy for what 

was likely septic shock ("low blood pressure and signs of an infection").



In addition, cases of community-acquired _C. difficile_-associated 

diarrhea (CA-CDAD) are increasing, and half of these cases have been 

reported to be not attributable to antibiotic use.



A map of England showing the location of Gloucestershire can be found at



Clostridium difficile - Canada (QC) 20070613.1932

Clostridium difficile, ribotype 027, 2005-2006 - UK (England), 

Ireland 20070427.1377

Clostridium difficile, ribotype 027 - UK (England) 20070410.1203

Clostridium difficile - Canada (ON, QC) 20070306.0791

Clostridium difficile, mortality, 2000-2005 - UK (England, Wales) 20070222.0661

Clostridium difficile - UK (Scotland) 20070209.0508

2006

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Clostridium difficile, increased virulence - UK (England) 20061228.3639

Clostridium difficile - Canada (QC) (03) 20061110.3234

Clostridium difficile - Canada (QC) 20061029.3100

Clostridium difficile, community acquired - USA (NC) 20061018.2990

Clostridium difficile, ribotype 027 - UK (England) 20061002.2825

Clostridium difficile, ribotype 027 - France, Belgium, Austria 20060915.2617

Clostridium difficile, ribotype 027 - France 20060505.1299

2005

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Clostridium difficile, increased virulence - USA (multistate) 20051202.3472

Clostridium difficile, ribotype 027 - Belgium 20051021.3071

Clostridium difficile, increased virulence - Netherlands 20050706.1912

Clostridium difficile, increased virulence - UK (England) (05) 20050630.1843

Clostridium difficile, increased virulence - UK (England) 20050606.1572

Clostridium difficile, increased virulence, 2004 - USA, Canada 20050412.1055

2004

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Clostridium difficile, increased virulence - USA 20041004.2735

Clostridium difficile, fatal - Canada (QC) 20040808.2191]

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