Map of life expectancy at birth from Global Education Project.

Thursday, February 26, 2015

Sí, es muy difícil

Actually it's not Spanish for "difficult," it's Clostridium difficile, an intestinal infection which, take it from me, you want to stay a light year away from. It causes diarrhea which is beyond description, and I know because I had it.

It's been a few years, I think, since I discussed my personal history here, but while George Bush the First was busy bombing Iraq, I was in Beth Israel Medical Center in Boston having my ascending colon removed. It's a long story with many interesting lessons, but it was now almost 25 years ago so some -- though not all -- of the lessons are no longer operative. Anyway, the surgery was unnecessary, I did not in fact have cancer. I would rather still have the ascending colon, however.

I was in the hospital for 11 nights, due to various complications, C. diff being one of them. This is an opportunistic infection that happens when your symbiotic intestinal microbiota gets wiped out by antibiotics. Back then, it was pretty much limited to hospitals and nursing homes, but as the linked report in NEJM says, that's no longer the case. Only about 25% of cases have their origin in hospitals. The authors estimate, based on regional surveillance, that there were 453,000 incident cases in the U.S. in 2011, and 29,000 deaths. That's not a big bar on the cause of death graphic but it's particularly disturbing since it's mostly iatrogenic, and the problem appears to be getting worse.

Again, folks, I cannot emphasize this enough. When you need antibiotics, you may really, really need them. But do not take them if you don't need to. Make sure to have this discussion with your doctor; do not demand antibiotics if your doctor doesn't think you need them. And wash your hands, with soap.


mojrim said...

So, should we expect an increase in fecal transplants to compensate?

Cervantes said...

That may happen -- they're experimenting with it. Less yucky would be creating a culture of a good mix of microbes, but I don't think they've quite figured out what that should be.