What is C. difficile?

Dr. Brian Bressler

Clostridium difficile, more commonly referred to as C. difficile or C.diff, is a particular type of bacteria found in the intestine of virtually every person. Most people will live with C. diff bacteria their entire lives without experiencing a problem as long as they keep a healthy balance of good bacteria to keep the C. diff in check.

The problem begins when this balance between health and unhealthy bacteria is upset, which creates an opportunity for the C. diff bacteria to multiply. And it is this overgrowth that causes an infection.

Causes of C. difficile infection

The most common reason for the overgrowth of C. diff bacteria is the use of antibiotic medications. While antibiotics fight bacterial infections, they also tend to destroy the beneficial bacteria that help maintain the bacterial balance in the intestine. When healthy bacteria are suppressed, it allows the C. diff bacteria an opportunity to quickly multiply and grow out of proportion.

C. diff can also be passed from person to person. If a caregiver or healthcare worker comes in contact with an infected person’s feces directly or through handling soiled linens or clothing and then touches their mouth or mucous membranes, they can contract the C. diff infection.

A person is also at greater risk for C. diff infection if they have inflammatory bowel disease (Crohn’s disease or ulcerative colitis), a weakened immune system, reside in a long-term care facility or have used antibiotics for a prolonged amount of time.

Symptoms

As the C. diff bacteria grow, they attack the lining of the large intestine causing inflammation. This inflammation can range from mild to severe and symptoms vary. In mild to moderate C. diff infection, frequent bouts of watery diarrhea and abdominal cramping are common. In more severe C. diff infections, fever, nausea, dehydration, blood in the stool or a swollen abdomen may be present.

If any of these symptoms persist over several days, it is important to seek medical attention. A severe C. diff infection can be life threatening. Dehydration from loss of fluids is of major concern. The infection can also cause the colon to swell to the point of rupture or it may perforate the colon, creating an opening that allows the infection to spread into the abdominal cavity.

Diagnosis/testing

Doctors are usually suspicious about the possibility of C. diff in anyone that is experiencing diarrhea and has been on antibiotics for at least two months or who develops diarrhea after being in the hospital for more than a few days. A stool test to detect the presence of C. diff is usually the first step in getting an accurate diagnosis. In more severe cases, your doctor may request an x-ray or CT scan of your colon to see if there are additional concerns, such as a perforation or swelling of the intestine.

Treatment

Fortunately, there are a few oral antibiotics that target the C. diff infection. They go by the names: Metronidazole, Vancomycin and Fidaxomin. Typically, one of these is prescribed for at least ten days to help increase the amount of healthy bacteria in the intestine and hinder the overgrowth of C. diff.

Despite the effectiveness of these antibiotics, about one in five people experience a recurrence of C. diff at some point. Older adults are especially at risk for recurrence of C. diff infection.

Clinical trials have shown that transplanting stool (called a fecal transplant) from a healthy person to a person with C. diff has been shown to be 90% effective in preventing recurrence of the C. diff infection. But, more research is needed to establish the long-term safety of fecal transplants.

Preventive measures go a long way toward keeping C. diff from spreading to others and reduces the likelihood of recurrence. Best preventive practices include:

  • Use antibiotics only when necessary
  • Practice frequent and immediate hand washing, especially after direct care contact or following a visit to someone in a hospital or long-term care facility
  • Wash clothing and linens used by the person with C. diff on a regular basis
  • Use disposable gloves when caring for someone with C. diff
  • Use a chlorine bleach-based product to clean frequently touched surfaces, such as toilet seats, telephones and doorknobs

References

C. diff: Causes, Symptoms, and Treatments. (n.d.). Retrieved from http://www.webmd.com/digestive-disorders/clostridium-difficile-colitis#1
C. difficile infection Symptoms and causes - Mayo Clinic. (n.d.). Retrieved from http://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/dxc-20202389
C. Difficile Infection | ACG Patients. (n.d.). Retrieved from http://patients.gi.org/topics/c-difficile-infection/
Clostridium difficile Infection Information for Patients | HAI | CDC. (n.d.). Retrieved from https://www.cdc.gov/hai/organisms/cdiff/cdiff-patient.html