By Maureen Gallagher, MD
A Clostridium difficile infection, often shortened to C. difficile or C. diff., starts in the intestines and is caused by a specific bacterium. In some people, the infection causes symptoms like diarrhea. In others it causes severe illness. The Centers for Disease Control and Prevention (CDC) found that “C. difficile caused almost half a million infections among patients in the United States in a single year. An estimated 15,000 deaths are directly attributable to C. difficile infections, making it a substantial cause of infectious disease death in the United States.”
Causes
C. difficile is found in feces. Anything that is contaminated with feces, including toilets, bath tubs, and rectal thermometers can serve as an environment for C. difficile spores. In a healthcare setting, these spores are then transferred to patients primarily on the hands of healthcare workers who have touched a contaminated surface or item. C. difficile can live for long periods on surfaces.
C. difficile bacteria produces toxins as it grows. These toxins irritate the intestinal lining, leading to swelling, pain, and diarrhea. The intestines normally have a healthy balance of bacteria that helps with digestion. Antibiotics can disturb this balance by killing some bacteria and letting others grow in their place. If the C. difficile infection is present, it may be able to grow after a person takes certain antibiotics. In addition, C. difficile also can be picked up in the environment, passing from soiled surfaces to the hands, and then to the mouth.
Risk Factors
A risk factor is something that increases the chances of developing a disease or condition. A C. difficile infection is most common in older people, or people staying in hospitals or other care centers. Other risk factors that increase your chance of having this condition include:
- Taking certain medications, such as antibiotics, proton pump inhibitors, or those that decrease stomach acid production
- Increasing age (> 65 years old)
- Recent hospital stay
- Having intestinal diseases like Crohn’s disease or ulcerative colitis
- Having stomach or intestinal surgery
- Chemotherapy
- Enteral feeding
- History of C. difficile infection(s)
- Weakened immune system
- Poor hygiene, such as lack of proper hand washing
Symptoms
Those who have symptoms of a C. difficile infection, may experience:
- Watery diarrhea—at least 3 times within 24 hours
- Abdominal pain or cramps
- Bloating
- Fever
- Loss of appetite
- Loose stools
- Watery or mucousy diarrhea
Severe symptoms can include:
- Frequent, watery diarrhea (up to 15 times each day)
- Severe stomach pain or tenderness
- Nausea and vomiting
- Low-grade fever of up to 101°F in children or 100°F to 102°F in adults
- Blood or pus in your stool
Call your doctor if:
- Symptoms begin after taking an antibiotic
- Symptoms last longer than 3 days or get worse
Diagnosis
The doctor will ask about your symptoms and medical history, and a physical exam will be done. A C. difficile diagnosis is based on your symptoms and test results. Tests may include:
- Stool tests—to detect the bacterium and identify its toxins
- Blood tests—to check blood cell counts and kidney function
- Endoscopy—to collect intestinal cell samples and check for damage
- Colonoscopy to see the colon lining with a thin, lighted tube inserted through the rectum
- Imaging tests:
- X-rays
- CT scan
Treatment
People with C. difficile who do not have symptoms do not need treatment. If medications, such as antibiotics, are contributing to the infection, they should be stopped or changed. Mild infections will usually go away with time. If needed, treatment may include:
Medications
C. difficile is treated with antibiotics. Different antibiotics are available depending on how severe the infection is. You may also be given probiotics. These are healthy bacteria that will help your intestine get back to normal. Try not to use antidiarrheal drugs, which slow your gut motility.
Fluid Replacement
Severe diarrhea makes it difficult for your body to take in and keep fluids. A physician may recommend fluid treatments to help replace lost fluids. Your doctor may simply encourage you to drink more fluids. For severe fluid loss, your doctor may recommend an IV to deliver fluids directly to your bloodstream.
Fecal Microbiota Transplant
Healthy stool bacteria from a donor is used to help restore a healthy balance of bacteria in the colon.
Surgery
In very severe cases, surgery may be needed, though this is rare. If severe or repeated C. difficile infections do need treatment with surgery, it may include:
- Partial colectomy — The affected part of the colon is removed and the 2 healthy ends of the colon are joined together.
- Ileostomy with irrigation — The small intestine is brought through the abdominal wall. This opening allows stool to leave the body, and a liquid is used to flush the infected part of colon.
Prevention
Proper hand washing is the best way to prevent C. difficile from spreading. Wash your hands with soap and water, especially after using the bathroom. Other preventive methods include:
- Wash your hands often with soap and water to prevent spreading the infection.
- Probiotics—healthy bacteria that can be found in certain foods or supplements.
- Using medications as instructed by the prescribing physician. Do not take antibiotics unless a doctor prescribes them.
- Cleaning surfaces with disinfectants that contain bleach, especially if someone at home is sick.
- Making sure that any healthcare worker who comes in contact with you washes their hands first.
- Ask any visitors to wash their hands while visiting with you.
- Taking precautions in the hospital if you have a C. difficile infection. This should include gloves and protective gowns for staff or visitors.
Sources:
American Academy of Family Physicians
Centers for Disease Control and Prevention (CDC)