I got infected in a hospital while already suffering from an autoimmune flare. I was isolated for a week, hazmat suits, the works. Lost 15lbs in the hospital and had to take antibiotics for 3 months to make sure any resistant spores were killed. I’ve heard that fecal transplants have a very high success rate in curing Cdiff but didn’t have that option at the time.
These infections are a huge problem. My neighbor missed 2 _years_ of college recovering from a C. diff infection. And you are correct: fecal transplant is the way, for now.
Per the article, these bleach (sodium hypochlorite) resistant spores are a HUGE problem. At my office, we clean surfaces with quaternary ammonium compounds, and those are supposed to be superior against spores. But still, if the required contact times to disinfect surfaces keep increasing in healthcare settings, we are going to have a major issue where only the most resistant spore-forming bacterial strains survive (basically, we'll be selecting for the strongest... you know, evolution).
> basically, we'll be selecting for the strongest... you know, evolution
Fortunately TANSTAAFL[0] applies to evolution as well, right? Specific adaptations come with increased metabolic cost, so e.g. strongly bleach-resistant bacteria should eventually start losing resistance to other antimicrobials/antiseptics. Right?
Transplants are typically reserved for those with recurrent CDI (although that is likely different in the US where I think you can pay for one privately). In Canada it is a covered procedure.
Not sure about Canada anymore, Queens was doing this in select cases when I was there, but FMT is also increasingly used for initial episode fulminant CDI in the US as well (varies by institution).
I was unlucky enough to get CDI in medical school when flagyl was first line and had to pay OOP for PO vanco, I assume that’s changed now.
What’s first line in Canada these days, is fidaxomycin covered?
Couldn’t tell you about inpatient hospital use. Outside of hospital, it’s covered by the public drug plan in Ontario if you’ve failed (or have allergies to) vancomycin treatment.
Metronidazole is still first line under that program for “mild” cases, otherwise it’s vanco. But nobody is really checking, so it comes down to how your doctor wants to document it.
Glad to hear approval for vanco is relaxed, this was 2015 when I think vanco first line was still new. I was also on the university drug plan which required documented treatment failure at that time.
I remember we used to give patients vanco IV bags to drink on discharge for outpatient therapy because the PO formulation was too expensive for some (iirc I paid $300 for a 10 day course).
The standup set that put Tig Notaro on the cultural radar centered around getting pneumonia, catching c diff, and then her mother dies from a freak head injury and she gets diagnosed with breast cancer. She was never what anyone would call 'sturdy' to begin with. I can only imagine she looked like Skeletor by the end.
