Many severe diarrheal diseases

DGVS study: number of serious diarrheal diseases is increasing rapidly in Germany

07/10/2014

The number of severe intestinal infections that need to be treated in hospital has risen rapidly in Germany. This reports the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) in the current issue of „Journal of Gastroenterology“. According to this, in the year 2000 around 128,000 people were treated in hospitals for severe diarrhea. By 2011, the number more than doubled, with some 282,000 cases. In particular, infections with the bacterium Clostridium difficile, which can spread after antibiotic therapy in the intestine, occur more frequently.

Cause of diarrhea is often an infection with Clostridium difficile bacteria
„Clostridium difficile bacteria are widespread in the environment and also occur in many healthy people in the intestine“, explains study author Prof. Markus Lerch, Director of the Department of Internal Medicine A at Greifswald University Hospital and President of DGVS, to the news agency „AFP“. By taking antibiotics, however, the healthy intestinal flora can get out of whack. Normally, protective microorganisms colonize the intestinal mucosa. However, if these are decimated by antibiotics, the pathogenic Clostridium difficile bacteria can spread more. The danger of these pathogens comes from their poison, which paralyzes the intestinal wall and a balloon-like expansion of the colon, a „toxic megacolon“, can cause.

On the basis of data from the Federal Statistical Office, private lecturer Petra Lynen Jansen and her team found that the number of patients hospitalized due to an infection with Clostridium difficile had increased significantly in Germany. In 2011, nearly 28,200 people were admitted to hospitals with this diarrhea diagnosis. As recently as 2000, there were only about 1,300. „These data are alarming and once again urge us to make targeted use of antibiotics“, warns Prof. Ansgar Lohse, director of the 1st Medical Clinic at the University Medical Center Hamburg Eppendorf, to the news agency. 15 to 20 percent of the diarrheal diseases associated with taking antibiotics would be triggered by Clostridium difficile. The scientists suspect that a large proportion of deaths in gastrointestinal infections is due to this pathogen. „In 2011, a total of 4,152 patients died in hospital-related gastrointestinal infections“, reports Lerch. „Based on mortality rates from the USA, we assume that at least 2,000 people in Germany die each year from Clostridium difficile infections“.

Especially elderly people at risk of gastrointestinal infections
The severe and even fatal disease patterns usually occur in older people. In Clostridium difficile infections, more than 80 percent of patients were over 65 years old. „Infections in the gastrointestinal tract, especially older people are at risk“, explains co-author Prof. Andreas Stallmach, Director of the Department of Internal Medicine IV at the University Hospital Jena, to the news agency. Even with virus-related intestinal infections, most of which affect children, according to the scientists, the proportion of older patients is increasing. „We assume that demographic development will further aggravate the problem of intestinal infections“, says Stallmach.

In addition to Clostridium difficile, infections with norovirus, rotavirus, Campylobacter and E. coli bacteria are also increasing. Gastrointestinal infections are now among the most common infections in Germany, with more than half a million cases treated in hospitals each year. „To meet the growing challenge, we need to improve the education and training of gastroenterologists in the field of infectiology“, demands Lerch.

Use of antibiotics often unnecessary
The Federal Office for Consumer Protection and Food Safety, the Paul Ehrlich Society for Chemotherapy e. V. and the University Clinic of Freiburg published the third report (GERMAP 2012) on the development of antibiotic consumption and the spread of antibiotic resistance in human and veterinary medicine in Germany at the end of June. In this study, the scientists came to the conclusion that infections with the pathogen Clostridium difficile have noticeably increased. In addition, they indicate that new antibiotic resistance of some strains has developed since the publication of the first report in 2008.

„The proper use of antibiotics is more necessary than ever, because in the near future only a few (human medicine) or not (veterinary medicine) with new active ingredients or even drug classes is to be expected. It is all the more important to maintain the efficacy of the active ingredients currently used“ emphasize the authors of the report. „Proper and intelligent use of antibiotics means being able to decide in the specific situation whether - and if so - which antibiotic should be used in which dosage and with which application form.“ (Ag)