Excessive Antibiotics Can Increase Your Risk Of Post-Surgical Infection 1200%

The genus Clostridium includes more than 60 species of especially aggressive bacteria. They produce a variety of infections that few other families of bacteria can match. Unlike most opportunistic infections that take advantage of damaged immune systems,  Clostridia strike people with active immune systems.

Clostridia grow in the absence of oxygen. They produce a dizzy array of potent toxins. One species of Clostridium produces the deadly botulinum toxin, the cause of potentially fatal food poisoning, but also the nerve paralyzing agent Botox. The species Clostridium perfringens can produce another dozen bacterial byproducts that can irritate the colon and destroy tissue.

For most of the twentieth century, Clostridia were mostly associated with gangrene in wounds and massive infections after back alley abortions. Medical journals were filled with lurid reports about patients with deadly illnesses caused by rotting tissue. In recent years, however, Clostridium species have become even better known as the source of infections acquired in hospitals.

The Explosive Spread of Infections with Clostridium dificile

One particular species of Clostridia has become a major problem for Americans at large. Clostridium dificile is associated with an especially unpleasant form of diarrhea. Usually contracted in a hospital, these bacteria trigger an especially unpleasant form of diarrhea. First there is intense abdominal pain. Then the bowels empty themselves of their entire contents, usually explosively. Then there can be intense sweating, difficulty breathing, and even loss of consciousness – if the patient is lucky. In the most severe cases, the bacteria can destroy tissue in the bowel, leaking into the bloodstream, causing a condition called septicemia, which is rapidly fatal if not controlled by intravenous antibiotics which have to be administered in a hospital. Tissue damage is especially problematic if the infection is acquired in a hospital during recovery from bowel surgery.

Up to three million people every year in the United States alone catch Clostridium infections while they are in the hospital. Between 2000 and 2009, the number of people in the United States who had to be admitted to hospital just for Clostridium infections increased from 139,000 to 336,000. Clostridia strike about half as many people in Europe, and even fewer in India and the rest of Asia, but is more common in parts of Canada (especially Quebec) than in the USA.

Who Is Susceptible to Clostridium Infection?

Clostridium infections are most common in newborns and in people over 60, but babies usually don’t develop diarrhea or other symptoms of the disease. They can, however, transmit the disease in dirty diapers. Until recently, most people over the age of one year and not yet senior citizens did not catch the infection unless they had inflammatory bowel disease or immune deficiencies, but recently there have been two disturbing trends:

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1. Many people who wouldn’t have been expected to catch Clostridium are coming down with the disease, and
2. Antibiotics that once controlled the infection no longer work.

Even worse, antibiotics to prevent other infections have been shown to increase the risk of infection with Clostridium. Three antibiotics are especially problematic.

The  Antibiotics You Don’t Want To Have Before Bowel Surgery

If you know you are going to have bowel surgery, or treatment for hemorrhoids, or even just a colonoscopy, the more antibiotics you are given, the more likely you are to develop a Clostridium infection. Generally, patients are given multiple classes of antibiotics when:

• Doctors don’t know what is causing an infection. (It can take two or three days to get results back from blood and fluid cultures.)
• Doctors are concerned that an infection may be resistant to common antibiotics, or
• Doctors note symptoms of sepsis (systemic inflammation caused by an infection in one part of the body) or septicemia (bacteria circulating in the bloodstream).

If there are serious symptoms of infection, doctors will usually try to hit every possible cause of infection while the microorganisms are being identified by the lab. It’s possible to have two, three, four, five, or even more different kinds of bacteria causing infection at the same time. As a result, hospitalized patients may get two, three, or even four IV antibiotics around the clock until doctors narrow down the possibilities that cause infection.

A newly admitted patient may be given intravenous Zosyn (piperacillin-tazobactam) to slow down a rapidly moving infection, vancomycin to stop MRSA, meropenem (Merrem) to stop a strep infection, and tigecyline (Tygacil) to stop E. coli infections of the skin. These medications have potent effects on infection, but they also have potent side effects.  It’s good medicine, even with all the potential side effects and the staggering cost of the drugs (up to $5,000 a day in hospital settings), to cover all the possibilities. However, a side effect of doing what often may be necessary to save a life during one infection sometimes sets the stage for a later infection with Clostridium dificile.

Antibiotics As Both Cause and Cure

Treating Clostridium requires a different approach. Most infections are treated with multiple antibiotics. Clostridium infections are treated, usually, with just one antibiotic at a time.

The reason Clostridium species get just one medication at a time is that killing off other bacteria allows antibiotic-resistant Clostridia to multiply. If you get rid of their competitors, and the antibiotic you are using doesn’t work, then you have a real problem. Multiple interventions don’t usually work when Clostridium is the problem.

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Clostridium Infections Not Just Acquired in the Hospital

If all of these infections took place just in the hospital, they would be easier to manage. However, Clostridium bacteria are everywhere. They are in dirt, in animal feces, in grass, and in the air. Ordinarily, our immune systems can eliminate the Clostridium bacteria we encounter in our daily lives, but when our immune systems are overwhelmed by infection, or when treatment with amoxicillin or clindamycin has left a niche in which Clostridia can grow, infection is more likely.

In recent years, 40 percent of Clostridium infections have been occurring in people who haven’t been in the hospital. Overuse of antibiotics can set the stage for potentially deadly disease.

It isn’t just antibiotics that increase the risk of Clostridium dificile infection. People who take fluoxetine (Prozac) or mirtazapine (Remeron) are at increased risk for infection. Certain medications for gastroesophageal reflux disease (GERD) also increase risk of this kind of infection. The most important rule to remember is to take all the antibiotics you need, but only the antibiotics you need. If you are having a dental procedure, maybe you should ask your dentist to use minimal antibiotic treatment. If you are a transplant patient, you should have a frank discussion of the problem  of Clostridium you’re your doctors. Make every effort to stay squeaky clean in hospital and at home to avoid potentially deadly disease.