By Stacey Burling, The Philadelphia Inquirer
In a medical system rife with complex equipment and outrageously expensive drugs, a Montgomery County hospital has turned to a cheap, low-tech solution for one of modern medicine's most challenging problems.
Holy Redeemer is using yogurt -- the kind you could buy at the grocery store -- to fight C. difficile, a hospital-acquired infection that has been growing throughout the country.
After dietitians began encouraging patients taking antibiotics to eat yogurt, the infection rate fell by two-thirds. Holy Redeemer has now expanded the program to its nursing-home residents.
"We were really surprised by how easy it was and how quick it worked," said Jeanie Ryan, a registered dietitian, who helped coordinate the effort. "It was just so sudden and such a big impact, that it was striking."
The Hospital & Healthsystem Association of Pennsylvania earlier this year gave Holy Redeemer an Innovation Award for the program.
Other hospitals remain skeptical. Thomas Jefferson University Hospital uses probiotics, or beneficial yeast and bacteria, in pill form only in clinically stable patients who must take antibiotics for long periods.
Neil Fishman, associate chief medical officer at the University of Pennsylvania Health System, said there was not enough science to support the wide use of yogurt or probiotics. They can be dangerous in patients with compromised immune systems.
He said the bacteria in yogurt were not native to the human digestive system and thus would not perform like the normal flora devastated by antibiotics.
Fishman wondered whether other measures helped reduce infection rates at Holy Redeemer. "I doubt strongly that a two-thirds reduction is just due to eating yogurt," said Fishman, who advises the Centers for Disease Control and Prevention on infection control. And "I love yogurt," he said.
The most effective way to reduce C. diff, he said, is to prescribe antibiotics more carefully.
Barbara L'Amoreaux, a Holy Redeemer spokeswoman, said there were no other changes in patient care in the year before the hospital asked patients to eat yogurt.
In 2011, Holy Redeemer officials became alarmed by the increasing numbers of hospital-acquired C. difficile cases. The bacteria cause severe diarrhea and can be fatal. Holy Redeemer had 75 hospital-acquired cases in 2011.
The bug is particularly hard to kill on surfaces, and the infection rate did not improve despite isolation of infected patients, education of the staff, and a change in disinfectants. The CDC says hospital cases nationwide have tripled in the last decade to nearly 337,000. Most C. difficile cases are related to medical care, but only about a quarter show symptoms first in the hospital, the CDC says. C. diff infections cost at least $1 billion in extra health-care costs annually.
At an infection-control committee meeting at Holy Redeemer, a surgeon suggested using probiotics against the bug. While antibiotics are essential for fighting infections, they also can throw off the delicate balance of bacteria in our bodies by weakening both good and bad microorganisms. Without the good bugs to keep it at bay, C. difficile can take off and make us sick.
Ryan and fellow dietitian Anne Kathryn Bromm knew that some hospitals were using probiotics in granular form, but they liked the idea of giving a food. Yogurt is popular, and it has the extra benefit of providing protein, vitamins, and energy. While some doctors for years have recommended it to patients on antibiotics, Bromm and Ryan could find little scientific evidence on whether yogurt would work in the hospital or which brand would be most effective.
After comparing many brands, they decided there was no good reason to pick one over another. The one they were already using -- Dannon -- contained three types of beneficial bacteria: S. thermophilius, L. bulgaricus, and L. acidophilus. They decided to start with it, expecting that they might later need to switch to others.
They decided to suggest two six-ounce servings a day to patients taking antibiotics. Dietitians met with each patient to explain the potential value of yogurt. There has been little resistance. Ryan estimates that only 5 percent of patients refuse the yogurt, although some aren't well enough to eat.
The idea has been "extremely well-received," Bromm said. "They have a good understanding of yogurt and probiotics."
Robert Baus, 78, a patient from Southampton, was happy to eat strawberry yogurt with his cod one day last week. He said he would have eaten it even without the medical justification. "It's very tasty," he said. "It's filling, and it's low on salt."
During 2012, the first year of the program, C. difficile cases fell by 52, to 23. This year, there were 21 cases through October.
While the dietitians have not done a scientific study of the program, Ryan said it seemed that patients who got C. diff infections were less likely to have eaten yogurt. "I really haven't come across many that were taking yogurt and did get C. diff," she said.
The hospital also has not done a cost-benefit analysis but says it clearly is cheaper to pay for yogurt than an ICU stay.
The facility definitely is buying more yogurt. In 2011, Holy Redeemer purchased 770 cases of yogurt, or 9,240 individual yogurt cups. In 2012, it ordered 4,664 cases of yogurt, or 55,968 yogurt cups.
BY THE NUMBERS
Number of cases of C. difficile each year at U.S. hospitals, a threefold increase, over the last decade.
Financial burden of treating C. diff infections each year.
Number of hospital-acquired cases of C. difficile at Holy Redeemer in 2011.
Number of cases at Holy Redeemer in 2012 after the Montgomery County hospital began encouraging patients to eat yogurt.
Cups of yogurt ordered by the hospital in 2012.
SOURCES: Centers for Disease Control
and Prevention; Holy Redeemer
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