C. difficile sickened almost half a million Americans in 2011, according to the most recent numbers from the U.S. Centers for Disease Control and Prevention (CDC). A newly approved drug may help in the battle against the superbug. In two clinical trials, researchers found that the drug, called bezlotoxumab, marketed as Zinplava, cut the risk of a recurrent C. difficile infection by almost 40%. That's important, because the gut infection commonly comes back after treatment with antibiotics approximately around 20% of the time, according to the U.S. Centers for Disease Control and Prevention (CDC).
The studies involved over 2,600 adults who all received antibiotics for a first-time or recurrent C. difficile infection. Some were randomly assigned to receive a Zinplava infusion, while the rest received a saline infusion that served as a placebo. Over 12 weeks, 16-17% of Zinplava patients suffered a recurrent infection. That compared with 26%-28% of placebo patients, the findings showed. The drug's main side effects included fever, nausea and diarrhea, which affected between 5-7% of patients. Dr. Mark Wilcox, a professor of medical microbiology at the University of Leeds, agreed that doctors will have to give the drug based on patients' personal odds of a recurrence. According to Wilcox, some high-risk patients include those who are age 65 or older, have a compromised immune system or have a severe C. difficile infection. "Bezlotoxumab was more effective in such patients," said Wilcox. "So doctors should consider adding it to standard-of-care antibiotics according to these risk factors."
Related Article: Antibiotic Overuse Behind 'Superbug' Outbreak in U.K. Hospitals
While the 2014-16 Africa Ebola outbreak taught physicians and scientists much about virus, many questions remain. Foremost among them: why do some people survive an infection, while others die? A team of researchers led by Boston University and other international agencies has discovered a biomarker that can help predict the progression of the disease: a handful of genes that are over-activated in patients who succumb to the disease. These genes indicate an overly aggressive primary immune response, which can damage organs—particularly the liver and paradoxically, may hamper a more targeted immune response.
Published in the journal Genome Biology, the research suggests a new type of blood test that while still in the preliminary stages of development, might be useful in future outbreaks to steer patients to the best treatment. When the researchers looked for biomarkers in blood samples, they found the test would correctly predict who survived or succumbed to the disease 70% of the time based on the biomarkers. Evidence was also found for activation in genes that make albumin and fibrinogen, indicators of severe liver damage. "Because the liver produces many critical molecules for the body, including proteins that allow blood to clot", says Connor, "the liver’s demise may be what gives the virus the upper hand in some patients."