C diff spores resist bleach and remain viable on surgical scrubs, fabrics
microbiologyresearch.org
microbiologyresearch.org
I worked on a drug program against a pathogen that was transmitted as spores. Basically the treatment was given when there was a flare up, because the organism was only vulnerable in that mode. We tried killing the spores themselves but evan at toxic-to-human doses the spores didn't give a shit. So people would get better, then have further outbreaks.
Note that from a drug company's perspective, this is actually pretty great. You don't treat them for long enough that it's considered a "chronic condition" from a regulatory perspective (which would mean much more complex trial protocols) yet you know if you treat anyone you'll have a repeat customer, probably for the rest of their lives. But despite public opinion of pharma companies, I never heard anyone say "thank you spores!" In fact we did continue to try to attack the spores.
You have conflated your incentive (a cure) with people who make and sell treatments (maximize profits).
As long as there are Pharma companies, there is incentive to make slightly better treatments. That is same effect lower production cost, or same cost and better effect.
It kind of sad that treatements have gone from prescription to subscription.
This is of course complicated further by the sheer pigheadedness of CEOs with a career half life of 3 years who come in, _revolutionize_ something by destroying it and antagonizing the workers, bloat HR a bit more and drive sales through something illegal; and finally move on, tallying that one a success.
https://www.propublica.org/article/how-big-pharma-company-st...
Two vaccine candidates use the same adjuvant. One demonstrates high efficacy at curing a disease killing over a million people per year in poorer countries, one demonstrates high efficacy in preventing shingles. Guess which one was prioritized for the adjuvant.
Also shingles can be a serious disease. Doesn’t change the calculus of prevalence, but no need to be quite so dismissive.
Regardless, it makes you wonder why they went forward with that particular adjuvant for the TB trial in the first case.
I'm not dismissing shingles, just triaging it relative to the seriousness of TB.
Well sometimes you select an excipient or adjuvant because some other one you might have chosen has some interaction with your API (active pharmaceutical ingredient -- the thing you're actually trying to deliver). More often though they are pretty arbitrary: the program lead or someone on the team had used that compund before and knew how to handle it or already had all the literature needed for a regulatory submission (had an older submission) or perhaps the division you're submitting to is already quite familiar with that one so you use it.
And of course once you're approved for and done an initial trial (phase 1) with one formulation you don't want to go back and redo all the safety studies, especially for something that isn't the API itself, if you don't have to.
Note, I have not worked in vaccines, only in anti-infectives, so their can always be cultural and technical differences that I'm not aware of! Consider this the equivalent of "experienced Lisp, C++ and assembly programmer reads article written by a layperson about a problem with a Java program, and is dubious about the layperson's diagnosis".
I don't know to what extent the ProPublica writer was informed by their sources, but they're typically pretty good journalists. Still, I get your point.
The patent is actually an argument for the cure. Because if you have a lifetime treatment, as the patent expires, anyone will be able to copy your treatment. It is called generic drugs and it is done all the time. If you have a cure, during the time you have the patent, you will be able to treat everyone, both existing and new cases, and make tons of money while your competitors will have nothing. After the patent expires and your competitors will be able to copy your cure, only new cases will remain. Still valuable, but far less than when you had the patent and there were plenty of people to cure.
https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie...
It's the same strategy bees use (modulo the heat). Honey can contain botulinum spores, but the pH is so low and the sugar crushingly high so it can't divide - until you try to make mead and fuck up the recipe. Or feed it to an infant.
Committing the sin of a double reply, different subject.
There are treatments for HSV, some experimental but I thought I heard one had just about cleared the FDA, that are a cocktail of drugs that kill serum herpes simplex but as a chaser to a drug that tricks HSV into coming out of dormancy. So while it would always be good for big pharma to spend more research on prevention and less on treatment, it's not like no progress is being made.
Whether they're sandbagging I really couldn't say.
I think this is a good example of the public imposing a sinister explanation on top of what is really an unfortunate reality: Pharma companies aren’t choosing to ignore the spore problem, they’re just focusing on treatments that can actually be made to work under our current technologies.
> biocide-exposed spores were spiked onto surgical scrubs and patient gowns and recovery was determined by a plate transfer assay
The article says nothing about washing scrubs and gowns. They put bleach-treated spores onto fabric, did not treat the fabric, and then collected samples from the fabric.
Also relevant for things that travel between rooms and are disinfected in between, like ultrasound machines.
Other studies have reported that spores can survive washing processes in use.
Spores alone survive the bleach. Spores + fabric will survive the bleach. Hence treated fabric cannot be considered safe.
it's tempting because it seems obvious.
If X + Y = Z, X on surface + Y = Z _must_ follow, because "on surface" was just a hidden term in X + Y = Z anyway...right?
But, both biology and fabrics have a lot of hidden surface (pun intended :P)
In theory, bleach could help decrease the adhesion of the spore to a surface. A possible mechanism would be if it oxidized — and so weakened/destroyed — some spiky organic hooks that the spores were using to adhere to the fabric.
Of course, agents other than bleach — things not normally considered biocides, in fact — would likely be a lot more effective at removing spores during fabric washing, since the goal is detachment, not lysing the spore.
The obvious things (detergents themselves, and other soaps) would work, of course, to varying degrees.
But also, less-obvious things could provide benefits here. For example, if spores tended to stay adhered to fabrics because they possessed a rough proteinous exosporium that acted sort of like nano-scale velcro, then conditioners (yes, like the kind you use in hair) might get that protein coat to relax and lay flatter, in a way that disrupts the velcro-like effect.
Lubricants might also work, by "filling up" the rough valleys of the spore's surface. (Of course, you'd then need an extra wash cycle to remove the lubricants.)
The downside to this magic stuff is that it's fairly expensive ($45 for 4 pounds). So, not for wanton use. But well worth it to solve tough problems or when time is more important than money.
I don't think it is. Isn't bleach itself an oxidizing agent?
Similarly why bleach wipes > soaking in bleach for disinfecting surfaces, as alluded to in this paper.
It might activate within the fabric if the conditions are right, but that's not very fast and you shouldn't be wearing scrubs contaminated by a nutritional substance for too long anyway.
I hear ya. But to mitigate any doubt they should have covered all their bases, or at least the base most inline witb real life.
This article explores surface disinfection (commonly bleach in the hospital). Although provider gowns are removed after entering contaminated rooms, disinfected surfaces commonly come into contact with provider scrubs which are not laundered in between same day patient encounters as well as other patients (such as the table of a CT or MRI).
I don’t see the gymnastics you’re referring to, other studies have looked at laundering processes which is not the focus of this study.
HOCl is generally considered the best disinfectant, and OCl- is weaker. Chlorinated cyanurates are very weak (and fairly UV-stable and non-irritating) and can replenish HOCl and OCl- as they are consumed.
Yet somehow the food-and-beverage-service standard for disinfection seems to be “100 ppm as Cl2” without regard to the balance of chlorine species.
On the other hand, this paper tested concentrations up to 10000ppm, which is really quite high.
If there's anything "difficile" they brought home from the hospital any day in the last few weeks, that's where it lives.
https://www.england.nhs.uk/wp-content/uploads/2020/04/Unifor...
Some places are still old fashioned though, I believe Mayo is still suit and tie.
https://en.wikipedia.org/wiki/Trehalose
> Outbreaks of Clostridium difficile were initially associated with trehalose. This finding was disputed in 2019.
I don't find "was disputed" conclusive there. The trehalose stuff got into ice cream, then C. Diff. became a widespread problem. They took it out of most of them, and C. Diff died back down.
I'll spare you exact details, but each sample put under microscope had clearly visible bacteria.
It looks like any infection could spread around the body and it handles it well. By well I mean three days of fever got rid of it
I had a surgery last January, broken labrum on both hips, left was "ok" and the right was really damaged, still it was an arthroscopic surgery and I could go on with my life 2 weeks after, but... 3 weeks after the surgery my right hip was getting worse, way worse, the pain was like nothing I have ever felt, I couldn't sleep, I couldn't walk, I couldn't even touch my fucking leg that I felt a nuclear bomb going off inside of it. No fever, puncture was ok, nothing that could deemed it as an infection. I was in literal agony, not even the strongest analgesics worked. I did a blood test and the PCR was off the charts, "yup, that's an infection, it's 10 AM, don't eat anything, today at 17hs you go in surgery".
I had a toilette done, infection was cleaned off but still I couldn't even move my leg, I lost all the muscle. Fast forward today, I had the worst 7 months of my life, antibiotics for 6 months but wait, there's more... Both infection and the initial cartilage problem evolved into a septic arthritis, last week I went into surgery again to have my hip replaced by a temporary spacer while the biopsy is performed and I will go in again in a month or so to get my definitive prosthesis.
For those who want to know, the bacteria was a Pseudomona.
So yeah, don't fuck with infections.
I did find places like HN and other outlets really helpful, little bit sized opportunities to nerd out and connect, that were just small enough that I could keep focus during the worst of things.
Good luck.
I’ve broken my olecranon (the pointy bit of your elbow) and declined surgery. I set it myself. Glad I did. It hurt. It wasn’t pleasant. But to me the risk of infection from being opened up for something so minor was too much of a risk. If I had internal bleeding or something I would have gone for it but a simple broken bone (even a joint) isn’t enough for me.
Yes some people get infections after surgery. Most do not.
The COVID vaccine killed some people. Most were fine.
Don't make your medical decisions based on anecdotes.
A decade later I can’t do an elbow plank without some pain usually and I can’t put a lot of weight on that part of my elbow. My favorite laptop position is on my belly on the floor so it sometimes hurts too much to do that.
I don’t know if surgery would have helped but it’s annoying sometimes.
IANAD but I know my own body, I know when something is wrong, when something isn't working right, and sometimes kicking your body's a$@ is what it needs. Like doing a purge. Or fasting to shock the system.
Pain reduction isn’t the main reason to operate or the metric of interest, there are many ways to alleviate acute pain including casting.
Functional impairment (immediate and delayed) and reducing the risks of posttraumatic arthritis are far more important.
Joint infections (and pseudomonas in general) are an absolute nightmare as the joint space is not vascular.
Bone infections/osteomyelitis are much rarer and for the most part less catastrophic (although they certainly still can be).
As always patient autonomy is paramount and we all value risks differently. For myself as a young healthy adult (not an orthopaedic surgeon) I would rather accept the minimal risks of surgical reduction and fixation for a fracture needing one than risk needing complex reconstruction or joint replacement in 10-20 years which has much higher complication rates and longer recovery.
there will be a point where the risk of infection is far outweighed by the reward of surgery.
Short answer: What? No, no way.
Long answer: It depends, If you can avoid being opened sure, avoid it like the plague, I've learned that the hard way that no matter how much sterilization is done, bacteria is there, and if your body is cut there's a chance bacteria could get in, but there are cases when you have no other road, like my case. Last December I couldn't walk a single complete street, the labrum was damaged to the point that the only solution was an arthroscopy, there was no option for me to say no. My surgeon told me "patients get infected, shit happens", but on top of that I got extremely unlucky, I got the worst fucking bacteria in the universe, I had no fever and the needle that was inserted in my hip to test for bacterial growth yielded negative results.
Pseudomonas infections are rare in healthy patients and few antibiotics work.
how can you have a bacterial infection in your hip that doesn’t make it to the rest of your body?
Fucking Pseudomonas.
Wife had appendicitis, or what looks like it. She had given birth a few months before and it didn't really go well. She had to have emergency surgery, and was pretty close to snuffing it.
Anyway, that healed, but she had some persistent pain, but that could just be scar tissue being a dick.
fast forward a few months, she has text book appendicitis symptoms. Now, as she's a doctor, she knows what it is, I know what it is, but she refuses to actually go into hospital. I drag her arse to the GP, who looks at me and says: "why haven't you taken her to A&E" I told the GP, that the patient knows too fucking much and won't listen to a muggle.
The GP turns to my wife and says: "you and I both know you need to go to hospital"
She goes in for assessment. Cant see much on the ultrasound. Go for a slice and dice to section the appendix.
Puss drained, appendix Yeeted, lots of IV antibiotics. Looks like a rampant infection rather than a swollen appendix.
Important note: men, topology wise, you are a doughnut. There is a tube from face to arse, and everything is mostly sealed(lungs are excluded for simplicity).
Women, are not doughnuts, There is a gap between the ovaries and the fallopian tubes, which from what I recall is only really sealed with "mucus".
This means that bacteria can get in from the outside. The hypothesis is that either when my wife was being professionally fisted by the midwives, or when she was being crash sewn up to stop her bleeding to death after the baby was born, is when Pseudomonas got in.
Thus, in conclusion, Pseudomonas can get to fuck.
It genuinely touches my heart that even on HN there is concern for strangers.
I'm wondering if this was pseudomonas aeruginosa.
Especially I think most 'nasty' infections are actually caught in hospitals.
At no time did the doctors say "we can keeping cutting it away, but who wants to wake up like that?" After the second surgery, was there even a remote chance he'd survive?
I truly can’t imagine what that man and his family went through in that short period of time. Decision making I slow decline with weeks or months is hard enough.
If the intervention is unequivocally futile for preserving life it is permitted to not offer care, there are processes in place.
While unlikely, it is possible to survive necrotizing fasciitis and multiple debridements. Although it will come with many months of reconstructions, rehabilitation and pain.
We are legally and ethically obligated to offer heroic life saving measures if there is a chance of surviving. Quality of life is not a factor in our decision making process.
I do not know the exact discussion was had with this patient and their decision maker when incapacitated but it would be extremely unusual for a previously healthy 32 year old to decline heroic interventions, this is also a very rapidly evolving infection where you don’t have much time to think.
With that said I’ve also met 80+ year olds who want major surgeries that will leave them significantly impaired and almost certainly fail despite having time to think. At the end of the day patient autonomy supersedes our thoughts and opinions.
> If the intervention is unequivocally futile for preserving life it is permitted to not offer care, there are processes in place.
I want it to be clear that patients are not abandoned in these cases. Even in cases of serious incurable illnesses where death is imminent and cannot be prevented, there's plenty of things that can be done to provide comfort, manage symptoms and improve quality of life. Orthothanasia.
As an example this is typically something like not offering CPR when death is imminent for another reason.
My cousin, an experienced surgeon, told me it'd be a quick operation and I'd probably be home in a few days. I spent over 40 days in the hospital due to a severe infection that ate through my abdominal wall and almost reached my skin. One week I was taking seven intravenous antibiotics at once. There was a moment where I became convinced I was going to die.
I was unlucky enough to get CDI in medical school when flagyl was first line and had to pay OOP for PO vanco, I assume that’s changed now.
What’s first line in Canada these days, is fidaxomycin covered?
Couldn’t tell you about inpatient hospital use. Outside of hospital, it’s covered by the public drug plan in Ontario if you’ve failed (or have allergies to) vancomycin treatment.
Metronidazole is still first line under that program for “mild” cases, otherwise it’s vanco. But nobody is really checking, so it comes down to how your doctor wants to document it.
Private drug coverage will vary in their rules.
I remember we used to give patients vanco IV bags to drink on discharge for outpatient therapy because the PO formulation was too expensive for some (iirc I paid $300 for a 10 day course).
Thanks for the info!
Per the article, these bleach (sodium hypochlorite) resistant spores are a HUGE problem. At my office, we clean surfaces with quaternary ammonium compounds, and those are supposed to be superior against spores. But still, if the required contact times to disinfect surfaces keep increasing in healthcare settings, we are going to have a major issue where only the most resistant spore-forming bacterial strains survive (basically, we'll be selecting for the strongest... you know, evolution).
Fortunately TANSTAAFL[0] applies to evolution as well, right? Specific adaptations come with increased metabolic cost, so e.g. strongly bleach-resistant bacteria should eventually start losing resistance to other antimicrobials/antiseptics. Right?
--
[0] - https://en.wikipedia.org/wiki/No_such_thing_as_a_free_lunch
Man. Way to rustle the ol' memory tree.
I think the first time I saw this in print was in Programming Perl back in the mid-1990's.
It did not originate there.
https://en.m.wikipedia.org/wiki/No_such_thing_as_a_free_lunc...
Pick a random (perhaps new) hospital, and make every patient live in their own sealed plastic bubble. No air goes in or out - instead it is recirculated per-patient like a space station. Make staff wear hazmat suits.
Then, after a few weeks, compare patient outcomes.
Personal experience in US academia also suggests not, far more concern for early diagnosis of infection and IPAC than I saw practicing in Canada.
Some more than others.
Of course these stats have their own gameability, but good luck getting this level of data elsewhere.
I suspect that the true figure for hospital acquired infections is far higher than 1 in 8, but that they are only recorded if the infection is serious enough to cause immediate medical treatment to be necessary.
When I was in hospital a few years ago, they swabbed on every admission to test for it so it's definitely a concern.
https://www.gov.uk/government/statistics/mrsa-bacteraemia-mo...
Just simply the staff having to change hazmat suits between patients, porting in and out between plastic bubbles, would add a lot of overhead and less time to offer actual care.
Not talking about all the risks involved with that "space station" like air recirculation. "Sorry about your grandma. She did not pick up an infection, but she died when the overworked technician forgot to replace her bubble's CO2 scrubber."
Not saying that the current situation is peak optimum and the best possible. Just that infection control is not the only goal to optimise for in a hospital.
For example, you can't run a food preparation place like a hospital.
However the NHS have done studies for side rooms vs group wards. there is a lot of prior research out there.
Boil washing is usually done at 90-95C, but I suppose you could achieve higher temperatures with a bit of extra pressure in a purpose-built machine. No living pathogen is known to survive an autoclave at 120C.
Steam might be similarly effective on fixed hard surfaces like stainless steel and linoleum. Any non-disposable material that cannot withstand bleach, alcohol, or 120C for a few seconds a day probably doesn't belong in a hospital anyway.
Regardless, the outcome is going to be shorter lifetime of these medical resources due to decay rate from the more aggressive treatment cycle.
Ah yes, the Hacker News tendency to gradually collectively re-invent existing technologies every now and then:
https://en.wikipedia.org/wiki/Autoclave
(No shade. Good thing, trying to think of solutions. It's just kinda funny to see.)
I went on a bender reading about c diff when I had it. The antibiotics for it have like 70% or less success rate [1]. The gold standard is a drug called dificid. With insurance my dificid was $1300, $4000 without insurance. There is a manufacturer coupon that makes the drug $50 with insurance - just a heads up if you ever find yourself in the same situation. The other antibiotics are not that great (vancomycin and metronidazole) and have more side effects, from my reading.
Fecal matter transplant (FMT) [2] seems to have the highest success rate [3]. There was recently a FDA approved drug for FMT called vowst, but its expensive as well. The whole science and process of FMT and FMT donors is super interesting and it will be exciting to see the developments in this field in the coming years to see what other things FMT can help out with (IBS, etc...). Its frustrating that FMT, with its high success rate, is considered a last resort method to cure c diff recurrence - it seems much safer than the general population using novel antiobitics with not-great success rates in preventing recurrence.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3867563/
[2] https://www.youtube.com/watch?v=i6RBfoITbls
[3] https://www.mayoclinic.org/medical-professionals/digestive-d....
PPIs have their downsides, but they're the best available treatment to avoid acid damage.
Probably time to start questioning some of the fundamentals of our modern healthcare setup.
BTW, a non-electronic pressure cooker does exactly that in almost any situation, off-grid and even in the bush.
> However, prions, such as those associated with Creutzfeldt–Jakob disease, and some toxins released by certain bacteria, such as Cereulide, may not be destroyed by autoclaving at the typical 134 °C for three minutes or 121 °C for 15 minutes and instead should be immersed in sodium hydroxide (1M NaOH) and heated in a gravity displacement autoclave at 121 °C for 30 min, cleaned, rinsed in water and subjected to routine sterilization.
Seems like we should just burn them like the parent suggested. Prions are no joke.
But also, you probably shouldn't have prions just floating around your environment in the first place.
Seeing C and diff here normally would mean the language and the program
It is recommended to wash your hands with water and soap, but if there is no visible dirtiness, hand sanitizer will do.
I barely recall an internet discussion where people were concerned about "super bugs" coming about from using alcohol to disinfect -- "will this not create a resistance in them by using the one tool we know works to kill bacteria" they inquired.
I recall a researcher saying it would be like humans becoming resistant to nuclear explosions. It just simply won't happen and yet here we are.
To continue the same analogy, humans will never become resistant to nuclear explosions, but we can build bunkers that allow us to last for varying lengths of time after one happens. The better the bunker, the longer we last.
If the alcohol isn't applied long enough then the longest lasting spores can make it through.
For better or for worse, watching a handful of YT videos from doctors saying "just wash the wound with soap and water" or even "all you need is to wash your hands with soap and water" has made me dial back the "douse it with alcohol" thinking.
I still use alcohol from time to time. Or hydrogen peroxide, depending. But at least now I'll get a fresh wound (cat bite or whatever) under a thorough rubbing with soap + water as the immediate first step. A thorough wash, at that.
As an aside, where can i reliably get any real UV-C + Ozone bulb these days? I had 3, i gave one away and two broke during the pandemic, and all i have been able to find in the past year and a half is UV-C that doesn't produce ozone, but instead that weird "too much sunlight" smell - anti-septic smelling but it doesn't murder pathogens like ozone does.
Edited to add: found it: https://archive.is/mtvCY
Also we don't really know that much of funghi, mosses, lichen & algae, and their symbiotic relations utilizing bacteria.
All in all a rather undiscovered territory.
But hopefully the intersection between radio-resistant, antibiotic-resistant and dangerous-to-humans is empty.
*Evolves a way to eat your gamma rays*
*Absorbs the DNA plasmids of any fallen bacteria like microscopic Mega Men*
Nothing personnel, kid.
1. We really should try harder to use the internet to reduce hospital visits. This was a missed opportunity during the pandemic when hospitals were a source of spread and hospitals are also an ongoing source of antibiotic resistant infections.
2. I wonder what copper would do in this case. Copper is sometimes used in hospitals for railings, etc. because microbes typically die within an hour, thereby reducing transmission of disease.
"Crops sprayed with 'barcoded' spores could help trace food poisoning...."
c. Diff is awful.