The human body is inhabited by billions of bacteria. Are everywhere. Among them is one really dangerous – Clostridioides difficile, which is activated when we disturb the world of microbes we carry within us. Most often it happens in a hospital – explains Prof. Waleria Hryniewicz, doctor – microbiologist from the National Medicines Institute. A man infected with the bacterium may feel pain similar to childbirth for the first time. Where is Clostridioides difficile lurking?
- Bacteria – from the Greek βακτήριον – means “stick, stick”. It is a group of unicellular microorganisms that often form colonies
- They inhabit, among others human body. They can have a beneficial or negative effect on our health. The latter are most often treated with selected antibiotics
- One of the dangerous bacteria is Clostridioides difficile, which causes diseases of the digestive system. In extreme cases, it can even lead to death
- The treatment can include the method of transplanting the bacterial flora from the intestine of a healthy person
- More current information can be found on the Onet homepage
Klaudia Torchała, Medonet: How many bacteria are there in the world?
Prof. Waleria Hryniewicz from the Department of Epidemiology and Clinical Microbiology of the National Medicines Institute: Billions and tens of thousands of species. We can’t even identify them all. You have to remember that most are useful species, but they are also useless.
Among those unhelpful is Clostridioides difficile. Why is she so dangerous to humans? Does it only become dangerous for him at some point?
It is a bacterium that is useless and pathogenic to humans. It is dangerous because if it enters our digestive tract and multiplies, it causes diarrhea, often severe. The digestive microbiome changes and the number of friendly bacteria is reduced. Remember that we have benevolent bacteria that live in various parts of our body that are not sterile. Those that are sterile do not have the right to exist, although they may appear temporarily. On the other hand, the entire digestive tract, intimate areas, throat, nose, nasopharynx are places that are not sterile, so there are various species of microorganisms. This natural flora plays a positive role. Not only does it produce a number of important compounds for us, e.g. vitamins, fatty acids and other substances important for our functioning, but its extremely important function is to prevent the entry of pathogenic bacteria. It simply blocks the receptors that pathogenic bacteria can use to invade our body.
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So theoretically we have an army that is ready to fight Clostridioides difficile? So why does this bacterium sometimes wreak so much havoc in our body?
Clostridioides difficile then has a chance when it multiplies and produces toxins massively. Most often, infection occurs in a hospital, and the administration of many drugs, especially antibiotics, disturbs the qualitative and quantitative relations in the microbiota of the gastrointestinal tract. Then these bacteria multiply and produce toxins, they become hostile to us …
Then maybe let’s stop for a moment. What is microbiota?
This is our entire microbial apparatus that we have. They are viruses, archaea, bacteria, fungi. They function in a certain balance in our body. As in the hematopoietic system, we have haemostasis, which means that all its elements “keep an eye on” that we do not bleed out. So the microbiota, the whole set of microbes we carry, make sure that nothing gets out of hand, but our interventions, sometimes saving lives, can disrupt this microbiome.
As you mentioned, are we actually most often infected in hospitals?
We most often get infected in hospitals, because there are crowds of sick people who undergo various procedures, extensive pharmacotherapy, with infections, and after chemotherapy. They take various types of drugs, and they often significantly disturb the microbiota. Also, strict infection control procedures that limit microbial transmission are not always in place.
More and more often it is heard that a restaurant or a public toilet is enough to get infected?
These are much rarer cases. There must be contact with a person who excretes this toxin-producing bacterium and does not maintain basic personal hygiene. To become infected, we must be susceptible, as with any infection.
What is the treatment? It starts with specific antibiotics?
First, we need to see what the patient is taking, especially what antibiotic, and whether it is possible to stop it. In some cases, this is enough to stop the disease process. However, if this is not medically possible, we try to replace the antibiotic you are using with one that has a lower diarrhea potential, Clostridioides difficile. There are antibiotics that carry a high risk, such as fluoroquinolones, which are consumed by Poles in large amounts, despite the fact that the leaflet contains warnings about this particular undesirable effect of this drug. High-risk drugs also include: ciprofloxacin, ofloxacin, levofloxacin and clindamycin. In turn, metronidazole, vancomycin and tetracyclines are much less likely to cause diarrhea.
Unfortunately, it is not always possible to defeat this bacterium. There are relapses. In such a situation, the intestinal flora transplantation remains?
Nobody recommends doing this after the first relapse. Most often, we think about such a procedure during the second relapse. About 20 percent. patients experience such a relapse after a few weeks. It is becoming more and more difficult for the patient to heal.
And what is this transplant?
Faeces are collected from a healthy donor. It is tested on all possible sides, for the presence of potentially dangerous pathogens from various groups of pathogens, such as viruses, bacteria, fungi and parasites, as well as for the presence of e.g. antibiotic resistance genes, genes responsible for the production of toxins, etc. This procedure is very restrictive and standardized. It must be conducted in an excellent laboratory, preferably one that is accredited. Then, the prepared suspension is administered to a patient qualified for this procedure. There are different methods, such as with a duodenal gavage or colonoscopy into the large intestine.
Where did the idea to heal feces come from?
It was a very brilliant approach – recreating the natural microbiota that we destroyed, for example by giving antibiotics too often. It is the administration of healthy flora to help the sick person. The method works well, but on the other hand you have to be very, very careful. There are countries that do not allow it, believing that there are still security concerns. Everything has to be tested: genes for resistance, virulence and other pathogens that may be dangerous for us. It must be a very broad panel of research. Although very rare, there is evidence that the Escherichia coli bacterium, which produces ESBL-β-lactamase, was passed on to the patient with the microbiome. It caused an infection and the patient died because an effective antibiotic could not be administered. It was one or two cases, and the transplantation of the intestinal flora is considered a safe procedure, but such feces for transplantation must be extremely strictly examined. There are attempts to prepare the so-called artificial faeces, which would consist of well-defined microbes. It would certainly be safer, but currently it has not been possible to develop a preparation with comparable effectiveness.
Do you think you may be a carrier of a dangerous bacterium? Do a test for the presence of strains of Clostridium difficile. You can buy a shipping test at Medonet Market.
We encourage you to listen to the latest episode of the RESET podcast. This time we devote it to one of the ways to deal with stress – the TRE method. What is it about? How does it release us from stress and trauma? Who is it intended for and who should definitely not use it? About this in the latest episode of our podcast.