“Fecal Cocktail” for Colon Infections Due to Clostridium Difficile



A new study finds that a “feces cocktail” may be a lifesaver for patients with

severe colon infection from the Clostridium difficile bacterium.


 

 

 

“FECAL COCKTAIL” FOR COLON INFECTIONS DUE TO CLOSTRIDIUM DIFFICILE

Warning:  You may not wish to read the following article if you are currently eating….

Many of us have a bacterium known as Clostridium difficile living in our colon.  As long as we remain in good health, the other bacteria that also live in our colon prevent overgrowth of Clostridium difficile.  However, when the “healthy” bacteria in our colon are killed off, Clostridium difficile can begin to grow, and may result in a potentially life-threatening infection, pseudomembranous colitis.  The most common cause of Clostridium difficile overgrowth is the use of antibiotics to treat other sites of infection in the body.  Following decades of excessive and inappropriate use of antibiotics, there has recently been an explosion in the number of cases of colitis caused by Clostridium difficile.  Moreover, as with many other “super bugs,” Clostridium difficile is becoming increasingly resistant to the antibiotics traditionally used to treat this bacterium.

Previously, there have been anecdotal reports of the use of suspensions of feces from “donors” to reestablish the normal, healthy bacteria in the colons of patients with colitis caused by Clostridium difficile.  However, this practice has not been formally studied.  Now, a newly published clinical study in the New England Journal of Medicine strongly suggests that patients with recurrent Clostridium difficile colitis may, indeed, benefit from a “feces cocktail” from healthy donors.

In this study, 42 patients with recurrent pseudomembranous colitis were randomized to three treatment groups.  The first group received the antibiotic vancomycin, followed by irrigation of their colon and the placement of “donor feces” into their small intestine through a tube passed through their nose.  The second group received vancomycin, alone.  The third group received vancomycin and colonic irrigation (but no “donor feces”).

Because of the marked superiority of the “fecal cocktail” as a treatment for recurrent Clostridium difficile colitis, this study was actually terminated prematurely.  Following a single duodenal infusion of “donor feces,” 81 percent of patients experienced resolution of their pseudomembranous colitis.  Of the remaining three patients with continuing diarrhea, a second infusion of “donor feces” resulted in the cure of two patients’ colitis, for a total cure rate of 94 percent associated with the administration of a “fecal cocktail.”  By comparison, only 31 percent of patients receiving vancomycin alone experienced resolution of their colitis, and only 23 percent of the patients who received vancomycin and bowel irrigation experienced a cure of their colitis.

The findings of this small pilot study could eventually lead to a rather dramatic change in the management of severe and recurrent colon infections associated with Clostridium difficile.  However, before we begin to routinely administer “fecal cocktails” to patients, larger clinical studies should be performed, and longer term follow-up should be performed, particularly to assess for the risk of infections with other types of bacteria and viruses known to be transmitted by the “fecal-oral” route.  While it may not be very appealing to consider, “fecal cocktails” may offer critically ill patients with life-threatening Clostridium difficile infections a chance for cure when antibiotics fail.

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Dr. Wascher’s latest video:

Dark as Night, Part 1


Dark as Night, Part 1

Dark as Night, Part 1


At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, more than 2.4 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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Dietary Fiber Significantly Reduces Risk of Death

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”



 

Dietary Fiber Significantly Reduces Risk of Death

Most of us already know that a high-fiber diet is an important part of a healthy lifestyle. Numerous previous research studies have associated a high-fiber diet with a decreased incidence of cardiovascular disease, diabetes, and some forms of cancer. However, there is very little research information available that directly links a high-fiber diet with a decreased risk of death from these or other diseases. Now, a newly published public health study puts some actual numbers on the potential health benefits of adding fiber to your diet. This study appears in the current issue of the Archives of Internal Medicine.

The NIH (National Institutes of Health)-AARP Diet and Health Study is an enormous prospective public health study, which has enrolled 219,123 men and 168,999 women between the ages of 50 and 71 years. All of these research study participants completed extensive dietary questionnaires, and all were closely followed for an average of 9 years.

During nearly a decade of follow-up, 20,126 men and 11,330 women participating in this study died of various causes. When the researchers compared the dietary fiber intake of the volunteers who died with those who did not die, several important findings were identified. High levels of dietary fiber intake appeared to decrease the risk of death for both men and women by about 22 percent, overall. A diet rich in fiber was also specifically linked to a significant reduction in the risk of death due to cardiovascular disease, infection, and respiratory disease in both men and women; while men (but not women) appeared to have a lower risk of death due to cancer if they consumed a fiber-rich diet. Finally, as has also been found in previous diet-based studies (including several of the Mediterranean diet studies that I cite in my book, A Cancer Prevention Guide for the Human Race), dietary fiber from whole grains appeared to provide the greatest benefit in terms of reducing the risk of death due to all causes.

While this study suffers from the same limitations as all other survey-based public health studies, its prospective methodology and its enormous population of research volunteers make this a very powerful public health study. Its finding that a diet rich in fiber (derived from whole grains) significantly reduces the risk of death from the most common global causes of death offer all of us an important strategy to improve our health and longevity.



For a comprehensive guide to living an evidence-based cancer prevention lifestyle, order your copy of my new book, A Cancer Prevention Guide for the Human Race.  For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million,Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.





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Prevention of Surgical Site Infections (SSIs) after Surgery

January 10, 2010 by  
Filed under Infection, surgery

Welcome to Weekly Health Update



 

“A critical weekly review of important new research findings for health-conscious readers”

PREVENTION OF SURGICAL SITE INFECTIONS

 

(SSIs) AFTER SURGERY

 

 

Infections following surgery in the United States occur in approximately 3 to 5 percent of all cases, and in more than 10 percent of certain types of operations.  In view of these statistics, surgical site infections (SSIs) are a major public health problem throughout the world.  On average, patients in the United States who develop an SSI will remain in the hospital for an additional week, resulting in an average of more than $25,000 in additional healthcare costs per affected patient.  Patients who develop SSIs are also 60 percent more likely to be admitted to the ICU, and are twice as likely to die, when compared to patients who do not develop SSIs following surgery.   Moreover, at a time when profound changes in the United State’s health care system are being proposed to control skyrocketing health care costs, SSIs are estimated to add an additional $10 billion in national health care costs, annually.   In addition to the economic costs associated with SSIs, serious infections following surgery often cause considerable suffering among affected patients; and in severe cases, SSIs can also result in permanent disability or death.

 

The known causes of SSIs are complex and multiple and, therefore, no single or simple solution is capable of eliminating all cases of SSIs.  However, there is ample research data available suggesting that a number of opportunities exist whereby the risk of SSIs can be further reduced.  For example, one major (and preventable) cause of potentially life-threatening SSIs is the increasing prevalence of antibiotic-resistant strains of bacteria that have developed following decades of excessive and inappropriate antibiotic use.  Among these resistant bacteria, few have raised more concern than methicillin-resistant Staphylococcus aureus (more commonly known by its acronym, MRSA).  MRSA is capable of causing limb- and life-threatening infections, particularly in very ill patients, and in the very young and very old.  When I began my medical career, more than 20 years ago, MRSA was an exceedingly rare cause of bacterial infections.  When MRSA first began to appear, this bacterium primarily caused infections among seriously ill hospitalized patients, and was rarely a source of infection among generally healthy nonhospitalized patients.

 

In a landmark study by the Centers for Disease Control, and published in the Journal of the American Medical Association in 2007, a remarkable 58 percent of invasive infections caused by MRSA in 2004 and 2005 occurred in nonhospitalized patients, while 27 percent of MRSA infections arose among hospitalized patients.  This tectonic shift in the epidemiology of MRSA (and other emerging strains of antibiotic-resistant bacteria and fungi, as well) has grave implications for preventing SSIs, as the majority of SSIs are known to arise from the surgical patient’s own native bacteria.

 

 

Two important new studies related to SSI prevention, and just published in The New England Journal of Medicine, offer important new ammunition in the ongoing fight against potentially deadly SSIs.

 

In the first study, from the Netherlands, patients being admitted to the hospital for elective surgery were tested for the presence of Staphylococcus aureus bacteria in their nasal passages.  In this prospective, randomized, placebo-controlled, double-blind, multi-center clinical research trial, 6,771 patients were screened for the presence of nasal Staphylococcus aureus, and 1,251 of these patients were confirmed to be nasal carriers of this bacterium.  A total of 917 of these patients were subsequently enrolled into this clinical research trial. These 917 patients were then divided into an “experimental” group and a “control” group, although neither the patients nor the research assistants in this double-blind study were permitted to know which group any patient was assigned to until after the study had been completed.  Patients randomized to the “experimental” group were treated, before surgery, with antibacterial ointment (mupirocin) applied to their nasal passages, and with showers using antibacterial soap (chlorhexidine), in an effort to eradicate surface bacteria (including Staphylococcus aureus) from their noses and skin.  The “control group” of patients received identical-appearing nasal ointment and skin soap, but without mupirocin or chlorhexidine.

 

All study patients were tracked following surgery, and the incidence of SSIs was then analyzed.  In this highly-powered randomized, controlled clinical research trial, there was a 58 percent overall reduction in the relative risk of SSIs among the “experimental group” of patients when compared to the patients who received only placebo ointment and placebo soap.  The benefit of preoperative treatment with mupirocin ointment and chlorhexidine soap was even more pronounced for SSIs involving deep body spaces, in this study: the relative risk of deep body space SSIs was reduced by 79 percent in the “experimental group” of patients.  Therefore, the results of this powerful prospective clinical trial suggest that SSIs following elective surgery can be significantly reduced by, first, testing patients for evidence of colonization with Staphylococcus aureus bacteria and, secondly, by “decolonizing” the nasal passages and skin of already-colonized patients with antibacterial ointment and soap, respectively.  Many hospitals already selectively apply nasal cavity testing for MRSA (either before or following surgery), and recommend a shower with chlorhexidine soap prior to surgery.  The results of this important public health study suggest that the incidence of SSIs can probably be further lowered by more rigorous and more universal preoperative screening programs for nasal Staphylococcus aureus (including both MRSA and non-MRSA Staphylococcus aureus) directed at all patients who are undergoing elective surgery.

 

 

The second, and related, study evaluated the impact of two different preoperative skin prep solutions on the incidence of SSIs.

 

For decades, now, iodine-based skin cleansing solutions have been applied to skin surfaces just prior to the start of surgery, in an effort to kill skin-surface bacteria that can lead to SSIs.  While these traditional iodine-based antibacterial skin prep solutions are active against many bacteria and fungi that are known to cause SSIs, their antibacterial and antifungal activity rapidly dissipates after being applied.  Newer surgical skin prep agents that contain alcohol and chlorhexidine have been shown by recent research studies to not only have a wider spectrum of activity against skin bacteria and fungi than traditional iodine-based prep solutions, but these newer surgical prep solutions also sustain their antibacterial and antifungal activity over a much longer duration than their iodine-based counterparts.  In this new prospective, randomized clinical research study, 849 patients undergoing elective surgery were randomized to one of two groups.  One group of patient volunteers underwent preoperative skin preparation with a commercially available chlorhexidine-alcohol solution, while the second group was randomized to undergo skin preparation with the traditional povidone-iodine solution.

 

Following surgery, 16 percent of the patients who had their skin prepped with povidone-iodine solution developed SSIs within 30 days of surgery, while just under 10 percent of the patients who received the chlorhexidine-alcohol skin prep solution subsequently developed SSIs.  (This 41 percent reduction in the relative risk of SSIs was found to be highly statistically significant.)    Although use of the chlorhexidine-alcohol skin prep, alone, did not appear to protect against deep organ-space infections (when compared with the use of povidone-iodine skin prep solutions) in this study, both superficial and deep SSIs of the surgical incision were significantly reduced following use of the chlorhexidine-alcohol skin prep solution.  In this study, the use of a chlorhexidine-alcohol prep solution cut the risk of superficial incisional infection by one-half, while deep incisional infections were reduced threefold.  Thus, the use of chlorhexidine-alcohol skin prep solutions, just prior to making the incision, was associated with a highly significant reduction in the incidence of both superficial and deep infections of surgical incisions when compared to traditional iodine-based prep solutions.

 

 

Taken together, these two very important prospective randomized clinical research trials offer clinically valuable lessons for patients, physicians, and hospitals in our crucial quest to drive down the incidence of SSIs to the lowest achievable level.  In view of the recent and ongoing emergence of highly virulent strains of bacteria and fungi that have become resistant to many of our most powerful antibiotic and antifungal drugs, respectively, it is imperative that we find new ways to reduce the risk of SSIs, and particularly new methods that do not involve the continued inappropriate or excessive utilization of broad spectrum antibiotic drugs.

 

If you are scheduled to undergo elective surgery in the near future, I would advocate that you share the findings of these two clinically important research studies with your surgeon (if they are not already aware of them).



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

 

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