Medical grant B&A

Before—Lay summary of a grant application

Clostridium difficile infection (CDI) begins when antibiotics are prescribed to individuals who are suffering from serious medical conditions and, as a consequence, have a diminished capacity to fight infection. CDI is the main cause of infectious diarrhea in hospitalized patients. Unfortunately, in addition to eradicating infectious organisms, many commonly prescribed antibiotics also alter the complexity and number of normal non-infectious microbes that populate the lower human gastrointestinal (GI) tract. Under these circumstances C. difficile, which is normally present in the environment, and now particularly hospital environments, can become established in a subject’s GI tract with serious, sometimes life-threatening, consequences. Presently in Calgary, hospitalized patients who are receiving antibiotics have a 1% chance of developing a CDI. Although this represents a low, or relatively low risk, during an outbreak in 2001-2002, the rate climbed to 3%. In Quebec, Niagara Ontario hospitals, Edmonton, and BC this year, CDI occurred at the same high frequency. C. difficile is the scourge of the elderly, and death due to infection occurs at a rate of 5% within 30 days of disease onset according to recent surveillance performed by Calgary Health Zone’s Infection Prevention and Control group. Moreover, although physicians presently have the capacity to treat the condition with more potent antibiotics, treatment failure still occurs in roughly 38% of CDI patients and the disease is increasingly occurring in non-hospitalized individuals. Clearly, we must adopt more effective measures to bring the escalating rate of CDI under control. Rates outside of North America have been 10 fold lower, particularly in the Netherlands and Scandinavian countries so CDI can clearly be controlled. There are multiple possible approaches to reducing CDI rates including; improved speed and accuracy of diagnosis, better infection control measures, better environmental sanitation, better treatments that kill C. difficile more completely, treatments which spare the health of protective non-infectious bacteria in the gut, a better understanding of how the microbe produces disease, and better characterization of the strain types and sources of strains in Alberta. All of these are likely to be incrementally effective in reducing disease. The overarching objective of this AI-HS Program CRIO, therefore, is to conduct a comprehensive 5-year program aimed at reducing the rate of CDI in Alberta. Whereas the current Infection Prevention and Control (IPC) program in the Calgary Health Zone has devoted significant effort to controlling disease rates in Alberta, the IPC program by itself does not have the human or other critical resources necessary to bring disease rates down in the most expeditious manner. As a consequence, this application describes a multi-disciplinary control program which combines Alberta Health Services and University of Calgary IPC, medical, and scientific staff to bring CDI rates down thereby improving patient safety, reducing health care costs, and improving efficiencies within Alberta’s Health Care system. The objective will be achieved by gaining a better understanding of the impact of CDI on the Alberta Health Care system and how the normal microflora in the human GI tract protects healthy individuals from developing this condition.

After—Lay summary of a grant application

The problem this application targets

This application proposes a comprehensive five-year program to reduce the rate of Clostridium difficile infection (CDI or C. difficile) in Alberta. CDI is a bacteria normally found in the environment. It is common in hospitals but stays in the background as long as healthy bacteria in the gut flourish. C difficile gets a foothold in weakened immune systems or when antibiotics suppress good bacteria in the digestive system. C. difficile infection can be life threatening for people with other serious health problems. In particular, elderly patients are at risk.

The human costs and burden on the health care system

Five percent of elderly patients die within 30 days of contracting CDI. Current treatments have a 38% failure rate. There are an estimated 4000 episodes of CDI in Alberta annually, which require 21,300 hospital days (days patients spend in hospital) for treatment. This translates into a $32million health care expenditure per year for beds alone.

Historically, CDI occurred in hospitals, but the bacteria is evolving. People who would not have been vulnerable to CDI ten years ago are now getting the disease. These new “hyper-virulent” C. difficile strains are also less responsive to treatment, making new research more urgent.

Creating a clinic as a focal point for research and treatment

A grant would bring together a team of doctors and researchers with strong backgrounds in CDI to work with Alberta Health Services, Infection Prevention and Control, and the University of Calgary. The program would open a clinic in Calgary to treat patients, research the disease, prevent its spread, and educate physicians and the community. In addition, it would research promising, new treatments to fight the disease.

We anticipate the clinic’s work will keep Albertans healthier and reduce health care costs. It will also set the province on track to match successes in other countries that have reduced CDI rates. Cost savings will likely significantly exceed the amount of the grant we are requesting.