Deadly new strains of C difficile superbug on the way, warn doctors

SCOTLAND must brace itself for an increase in new and severe strains of the Clostridium difficile superbug – and the infection could also become more resistant to the drugs used to treat it, experts have told The Scotsman.

Rising deaths from the bug, which can cause life-threatening illness and spreads easily in hospitals, have prompted concerns about virulent forms of the disease becoming more common in Scotland.

Now experts have predicted that cases involving severe strains could increase further in our hospitals, while new types of the disease are already starting to emerge.

Fears were also raised that C difficile could become less sensitive to the antibiotics currently used to treat it.

Earlier this month, it emerged that the infection was linked to almost 600 fatalities in Scotland in 2007 – up more than 40 per cent on the previous year.

The rise in cases has been linked to the growing prevalence of the 027 strain – or ribotype – of the disease, which first emerged in Scotland in 2006 but which has only become more common in the last year. It has been linked to more severe disease and deaths in patients, and is also thought to be better at spreading around hospitals than other strains.

Professor John Coia, director of Scottish Clostridium difficile Reference Service, said 027 was a concern for the NHS, but it was not the only strain causing death and disease.

He said: "For obvious reasons, people are concerned about 027. But to put it in perspective, I think 106 is something we have to be very aware of as well because it is the commonest type we see."

But while 027 has been the focus of much attention, other new strains are also starting to trouble microbiologists. One type – known as 078 – has recently emerged in Scotland.

In one study, scientists found that 078 was more likely to infect younger patients, but it has not yet been found to be any more severe than other strains.

Prof Coia, a consultant microbiologist at NHS Greater Glasgow and Clyde, said there was concern about 078 picking up resistance to antibiotics which could allow it to spread more easily, like other types.

Dr Anne Eastaway, a consultant microbiologist at Health Protection Scotland, said it was quite possible that new strains of C difficile could start to emerge – and some could be severe in nature.

Professor Ian Poxton, professor of microbial infection and immunity at Edinburgh University, said focusing on any one specific strain of C difficile would not help solve the problem.

"I think the biggest worry at the moment is everyone latches on to 027 and they think that is the only strain that is important," he said. "But certainly from the Edinburgh side, we have a lot of disease and none of it is caused by 027."

Strain is heading for Scotland, and we ignore it at our peril

PREDICTING what will happen next with Clostridium difficile in Scotland is a challenge for scientists and the NHS.

Our main source of information is from other countries. It is fair to say what happens in England and further afield will eventually happen in Scotland, as C difficile is very efficient at travelling around.

So, as they have seen rising rates of the virulent strain 027, we will probably see this continue to rise as well.

But it is not just 027 that we have to worry about. The other more common strains also cause severe and life-threatening disease and we ignore those at our peril.

It is likely that new strains will also appear and that is why it is so crucial that we have a referencing service to detect these strains when they do emerge.

At the moment there appears to be a consensus that the biggest concern is about the 027 strain of C difficile.

I would be surprised if the rise in cases of C difficile we have seen recently was linked to inappropriate use of antibiotics.

But another factor which could play a role in rising C difficile is the ageing population. More and more older people are going into hospital to have their hips done and knees replaced just because they are living longer.

Elderly people are more at risk of getting C difficile than young people. It is also likely that these patients will have had antibiotics at some point because they are more likely to get pneumonia.

To some extent we have to accept that more people are at risk these days.

PROFILE

• Clostridium difficile causes diarrhoea, and in the worst cases can lead to perforation of the intestine – and death.

• The infection is most common in elderly patients with other serious illnesses. Antibiotics can affect the balance of bacteria in the gut, allowing the infection to take hold.

• Although C difficile was first described in the 1930s, it was not identified as the cause of diarrhoea and colitis following antibiotic treatment until the late 1970s

• Between 3 and 5 per cent of the population are thought to carry C difficile in their gut at any one time without becoming ill.