Date: 2010/07/12

Byline: Jenn Marshall

MP draws attention to role meds play in c. diff outbreak

Acid suppressing medications might be playing a role in the Clostridium difficile outbreaks at Nanaimo Regional General Hospital, Nanaimo-Alberni MP James Lunney says.

Recent studies have shown that proton pump inhibitors, a class of acid suppressive drugs commonly used to treat heartburn and increase a patient’s tolerance for other drugs, increase the risk of C. difficile infection, said Lunney.

He wants Health Canada regulators to tighten controls on the commonly prescribed medication and Vancouver Island Health Authority officials to keep close tabs on patients using these drugs.

“This is the elephant in the room nobody wants to talk about,” said Lunney. “The higher the dose and the longer you’re on it, the greater the risk.”

The hospital has had three outbreaks of the bacterium in the past two years.

Eleven patients with the illness have died since the current outbreak began March 29, but only two of those deaths were directly attributed to C. diff and it played a role in two more of the deaths.

Patients on PPI medication were between 53 and 74 per cent more likely to be infected with C. diff, according to a study in the May 10 issue of the Archives of Internal Medicine.

“We have a factor here that I call a missed opportunity – to reduce our health-care costs,” said Lunney, who has written a letter to the health authority and raised the issue with Health Canada officials recently. “We have people dying in our own hospital. To me, one death is too many when it’s avoidable.”

Dr. Martin Wale, executive medical director of quality and patient safety and infection prevention and control with the Vancouver Island Health Authority, was unavailable for comment, but provided the News Bulletin with a written response.

The health authority is concerned about overuse of antibiotics because effects can include additional risk of C. diff infection, he wrote, and improving the prudent use of these antibiotics is part of VIHA’s current focus on infection prevention.

The same approach is applied to PPIs, Wale added, and the health authority is concerned about potential overuse.

Dr. Patricia Mark, a physician at the Sow’s Ear Medical Clinic in Lantzville, said PPIs are commonly prescribed for people, especially the elderly, to combat indigestion.

And physicians are aware of the risks, but risks are weighed by patient and doctor against the benefits, she said, and one benefit is in many cases the patient’s quality of life drastically improves on the medication.

“This is not news to anybody in the medical profession,” said Mark. “There’s no such thing as an innocent medication.”