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Published on 22 April 2008

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C diff “epidemic” prompts calls for new therapies

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The rapid spread of Clostridium difficile infection (CDI) constitutes an epidemic and an urgent health priority, specialists have warned.

The specialists made the plea for action at a symposium forming part of the 18th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), held in Barcelona, Spain.

Dr Ed Kuijper, medical microbiologist at Leiden University Medical Center, Netherlands, said the hypervirulent NAP1/027 strain of C difficile was largely responsible for this emerging epidemic along with routine antibiotic use, and a lack of facilities for isolating infected patients.

“Epidemics involving type NAP1/027 have affected more than 250 hospitals in 17 European countries.

“This underlines the importance of continuous surveillance to observe changes in the epidemiology of individual C difficile strains,” he said.

CDI, which is responsible for the most common form of hospital-acquired diarrhoea, affects one out of every 1,000 patients hospitalised in Europe, according to 2003 figures from the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), and more than 500,000 people in the USA, according to the US Centers for Disease Control.

Higher incidence and severity of CDI, increased rates of treatment failure with standard therapies and the emergence of the highly virulent epidemic strain have combined to create significant concern among public health officials, infectious disease specialists, gastroenterologists, microbiologists and epidemiologists.

Patients treated with broad-spectrum antibiotics (those that affect a wide range of bacteria, including intestinal bacteria) are at greatest risk of CDI.

Many of the patients affected are elderly with serious underlying illnesses.

Dr Mark Miller, head of infection prevention and control at the Jewish General Hospital, Montreal, Canada, said: “Important milestones in meeting the CDI challenge include developing next-generation therapies to improve clinical outcomes and also finding ways to enhance the body’s immunity to this infection.

“The most-commonly used available treatment, metronidazole, is now recognized to be inadequate for patients with moderate to severe CDI, leaving us with only one other option: the antibiotic vancomycin, which also has limitations.

“Newer and more efficacious treatments are desperately needed for this life-threatening illness.

“Companies developing new CDI therapies should focus on three goals: speed up the time to recovery, prevent relapsing disease after the end of therapy, and eliminate death and disability from this infection.”

The symposium was sponsored by US-based drug firm Optimer Pharmaceuticals.

ESCMID



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