Clostridium difficile, also known as C. difficile, or C. diff, is a bacterium which infects humans, and other animals. Symptoms can range from diarrhea to serious and potentially fatal inflammation of the colon.
Elderly hospital patients and those in long-term care facilities are most commonly affected by C. difficile - especially after, or during the use of antibiotic drugs.
C. difficile infection is gradually becoming more common, symptoms more severe, and harder to treat. In North America, Europe, Australasia, and many other parts of the world a significant number of otherwise healthy people are becoming ill from C. difficile.
C. difficile is generally treated with antibiotics. They type of antibiotic and the time-course of therapy depends on the severity of disease.
Contents of this article:
Fast facts on Clostridium difficile
Here are some key points about Clostridium difficile. More detail and supporting information is in the main article.
- Clostridium difficile infections are becoming more common, especially in healthcare settings
- C. diff is naturally present in the guts of some humans
- The majority of cases respond well to treatment
- Symptoms can include stomach ache, bloody stools, and diarrhea
What is Clostridium difficile?
C. diff naturally occurs in many people's intestines.
C. difficile is naturally present in the gut (intestinal tract). It is most often present in younger people and levels drop off as we age; it is present in 66 percent of babies and 3 percent of adults.
Healthy people are not usually affected by C. diff. However, some antibiotics may alter the balance of good bacteria in the gut, allowing C. diff to multiply and cause diarrhea, and possibly more serious illness.
Most cases of C. diff infection occur in healthcare environments because of their link to antibiotic therapy - a significant number of hospitalized patients are on antibiotics.
Older people are more susceptible to the infection and also more likely to experience worse symptoms. For instance, in 2010, more than 90 percent percent of all deaths due to C. difficile occurred in people over the age of 65.
The majority of patients with C. difficile infection recover completely without any long-term consequences but a small percentage, unfortunately, do have complications, and some of them die. It is also possible to be re-infected with C. diff after treatment.
According to the Centers for Disease Control and Prevention (CDC), in 2011, half a million patients were infected.
Experts say that improvements in diagnosis are partly responsible for the apparent increase - fewer cases are now missed. However, there is concern that the numbers are rising regardless.
Symptoms of C. difficile infection
The following signs and symptoms can occur as a result of C. difficile infection:
- Watery diarrhea (mild to severe)
- Bloody or blood-stained stools
- Elevated body temperature
- Tummy ache (mild abdominal cramps and tenderness)
The symptoms mentioned above are generally caused by inflammation of the lining of the large intestine (colitis). Although rare, C. difficile can also cause:
- Peritonitis - infection of the lining of the abdomen
- Septicemia - blood poisoning
- Perforation of the colon
Signs and symptoms in more severe cases may include:
- Elevated body temperature
- Loss of appetite
- More severe abdominal cramping and pain
- Pus or blood in stool (feces)
- Watery diarrhea - the patient may go to the toilet ten or more times in a day
- Weight loss
C. diff infection can be fatal; however, this is very rare. The risk of a life-threatening condition is higher among very elderly patients, as well as individuals with existing serious health conditions.
Most C. diff infection symptoms occur in patients who are taking antibiotic medications. It is not unusual for symptoms to appear 10 weeks after antibiotic therapy has stopped.
Risk factors for Clostridium difficile
Most C. diff cases occur in hospitals or other healthcare environments where germs may spread, and a high proportion of people are taking antibiotics. Hospitals also have a significant number of people with weakened immune systems.
The following groups of people have a higher-than-normal risk of becoming ill from C. diff infection:
- Patients taking antibiotics. The risk is higher if they are broad-spectrum antibiotics - those aimed at a wide range of bacteria. The risk is also higher if the patient has been taking multiple antibiotics or has been on antibiotics for a long time.
- Patients who were recently on antibiotics.
- Individuals aged 65 years or older.
- Anybody who was recently hospitalized. The risk is higher if this was for an extended period.
- People who live in a long-term care facility or nursing home.
- Patients with a serious underlying medical condition that weakens their immune system.
- People who have had abdominal or gastrointestinal surgery.
- Individuals with a colon disease.
- Patients who have had a previous infection with C. diff.
Causes of Clostridium difficile
C. diff is a bacterium which does not need oxygen to live and reproduce - it is anaerobic.
C. diff can be found in soil, water, and feces. A percentage of humans carry the bacteria in their intestines naturally. However, C. diff is most commonly found in healthcare environments, such as hospitals, nursing homes, and long-term healthcare facilities, where a significantly higher proportion of people carry the bacteria.
The bacterium can spread from feces to food, and then surfaces and other objects. The spread is greater if people do not wash their hands regularly and properly. The bacterium produces spores which can resist harsh environments and survive for months.
C. diff can be found in soil, water, and feces.
Our intestines have millions of different types of bacteria, many of which protect us from infection.
If a person takes antibiotics to treat an infection, some of the helpful bacteria may be destroyed, giving C. diff an opportunity to gain a foothold and reproduce more rapidly.
The following antibiotics are linked to C. diff infections - fluoroquinolones, cephalosporins, clindamycin, and penicillins; however, any antibiotic can increase the risk of C. diff.
As soon as C. diff bacteria have gained a foothold in a person's body, they produce toxins that destroy cells and produce areas of inflammatory cells and decaying cellular debris inside the colon.
There is a relatively new strain of C. diff which produces extremely potent toxins. This strain is resistant to many medications. Health experts are concerned that too many infections of this type are occurring in people who have not been taking antibiotics and have not been in hospital.
People with naturally-occurring C. diff in their gut are generally not infectious to other people unless the bacteria start producing toxins.
Diagnosis of C. difficile
If a C. diff infection is suspected, one or more of the following tests may be ordered:
- Stool test - this will determine whether toxins produced by C. diff are present.
- Flexible sigmoidoscopy - a flexible tube with a small camera at the end is inserted into the lower colon to seek signs of infection.
- Imaging scans - if the doctor suspects there is a chance of a C. diff complication, they may order a CT scan.
Treatment options for C. diff
If the patient has been taking an antibiotic during onset of symptoms, the doctor will assess if that antibiotic can be stopped. In addition, the doctor will start a new antibiotic to treat the C. diff and consider other therapies to treat the infection.
- Antibiotics - standard treatment for C. diff infection is an antibiotic - a different one if the patient was on an antibiotic when symptoms started. If symptoms are mild, the doctor may prescribe metronidazole (Flagyl). For more severe symptoms vancomycin (Vancocin) may be used.
- Probiotics - some types of bacteria and yeast help restore a healthy balance in the intestine. Saccharomyces boulardii, a natural yeast, together with antibiotics have been shown to reduce recurrences of C. diff infections.
- Surgery - if symptoms are severe, or if there is organ failure or perforation of the lining of the abdominal wall, it may be necessary to surgically remove the diseased portion of the colon.
- Bacteria cocktail wipes out C. diff in mice - scientists from the Wellcome Trust Sanger Institute, England, successfully wiped out the deadly bacterium in mice. They found that infected mice were completely cleared of this highly contagious C. diff strain when they were administered with a cocktail of six naturally-occurring bacteria.
- Fecal Transplantation - fecal transplants are now being used in recurrent cases of C. diff infection; fecal transplantation is when the bacteria from a healthy person's colon are transferred into a C. diff infected individual's colon. Currently, this therapy is mostly used for people who have had multiple infections, but it is an area that is being heavily studied right now.
Treating recurrences of C. diff infections
About 25 percent of patients infected with C. diff have recurrences. The infection may have occurred because the initial one was never completely eliminated, or a different strain of the bacteria has started to grow. Treatment may include:
- Probiotics - S. boulardii (type of yeast) together with an antibiotic
- Stool transplant
Prevention of C. diff infection
If hospitals and other healthcare establishments follow strict infection control guidelines, the spread of C. diff can be significantly reduced.
Even so, C. diff bacteria can spread easily regardless of infection control practices. The following measures will help stem the spread:
Visitors to healthcare facilities
- Before entering, and after leaving a patient's room, wash hands thoroughly with soap and water. Wash your hands again when you leave the hospital. Wash your hands with soap and water before eating or drinking.
- Do not sit on the beds.
- Adhere to all visiting guidelines.