C. Diff - Are you at Risk? 

A C. diff  infection is a type of bacterial infection that affects the digestive system. It is a highly infectious disease and is easily transmitted by touching any contaminated surface.  

This infection is caused by the bacterium clostridium difficile. The most likely place where this bacterium is found is in the colon, where it settles and can cause a colon inflammation or colitis. This type of colitis is basically a swelling of the colon caused by the clostridium difficile bacteria.

What Causes C. Diff Colitis?

C. diff bacteria live in the colon of an infected person; however, some people are carriers who have no symptoms themselves.

In addition to the live bacteria C. difficile also produces spores which are passed out of the human body in the feces (stool, poop, poo).

These spores can survive outside the body for several weeks, months and even years on surfaces and any object that they attach to. They are highly contagious.

If you accidentally touch a surface or object that is contaminated with the spores and then touch your mouth or nose, you can ingest them and they will turn back into bacteria inside your body.

If you are healthy, you have a much lower risk of having any problems. If however, there is an imbalance between ‘good’ bacteria and C. diff bacteria in the gut, the C. difficile will multiply and produce toxins, which cause the typical symptoms of a C. diff infection or CDI.

C. Diff - Are You at Risk? Women in discomfort

Symptoms of CDI

The symptoms of this infection can range from mild to severe. CDI symptoms include:

  • Foul smelling diarrhea, with watery stools and sometimes blood and/or mucus
  • Painful abdominal cramps
  • Nausea
  • Fever of 38 C (100.4F)or above

Abdominal cramps, diarrhea and nausea are common to several other disorders of the digestive tract. However, fever is the defining symptom of C. diff colitis. The fever comes on because the body reacts to the bacterial infection by raising the body temperature.

Who is Most at Risk?

Over 65s are more at risk than other age groups. Curiously, infected babies do not usually seem to suffer any ill effects.

People who have recently taken a course of antibiotics  especially broad spectrum ones (ampicillin, amoxicillin, clindamycin and cephalosporins such as Keflex are the most often implicated) are more at risk, as much of the healthy flora in their intestines has been killed and this natural protection is lost, allowing the C. diff bacteria to take over.

People using proton-pump inhibitors like esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole which reduce stomach acid are more at risk.

A stay in any health care facility - the longer you stay the more likely it becomes that you may contract CDI. Although low, rates of infection in the community are on the rise.

People who have underlying health conditions, especially those of the bowel like Crohn’s Disease and Ulcerative Colitis.

People who are immunosuppressed for whatever reason will, of course, be more likely to succumb. (For example people having chemotherapy)

Diagnosis

A stool sample is necessary to diagnose C. diff colitis. Carefully monitoring your body temperature also helps in the diagnosis.

In some cases, a doctor may ask you to do a few additional tests including a blood test, colonoscopy or a CT scan (this gives the most accurate diagnosis) to rule out other more serious conditions such as sepsis, which may also be caused by the C. difficile bacterium.

CDI is more than just an embarrassing condition. If left untreated the consequences can be serious, even fatal.

Timely diagnosis and immediate treatment are critical. Each year 14-20,000 people die in the USA from C. diff related problems. Of course, taking steps to prevent an infection is far better. 

How To Prevent a C. Difficile Infection

C. Diff - Liquid Soap

The single best thing you can do to avoid a CDI infection is to wash your hands as often as possible, especially after you visit any health care facility or hospital or if you are caring for someone who has this disease.

When caring for someone in the acute phase wear disposable gloves and aprons.

Always wash your hands after visiting the bathroom and before preparing food.

Did you know that the alcohol hand gels and sanitizers usually found in hospitals and other health care settings are ineffective against CDI?

Cleaning the bathroom regularly with an antibacterial cleaner such as a chlorine bleach will help lower the odds of an infection.

This is particularly important if you or a family member is at high risk for the disease.

Hospitals do not often use bleach as they have health and safety concerns for their staff but other cleaners and disinfectants do not kill C. diff and there is some evidence that in fact they could even make the bacteria and spores stronger.

Always put the lid down before you flush to prevent spores and bacteria coming up into the room and settling on surfaces.

Infected people should be isolated and use separate facilities.

The use of antibiotics should be limited to strictly necessary cases.

Take probiotics alongside antibiotics if you have to be treated with them.

In many countries the rates of infection in different health care facilities are published. If being admitted for elective surgery it is a good idea to find out the rates in the hospitals available to you and take this into account when making your decision.

Treatment


Mild Cases

It is quite often sufficient to stop taking the antibiotics (with your doctor’s consent) which may have precipitated the infection in the first place. This will allow the good bacteria in your bowel to regrow and fight back against the C. diff bacteria.

Moderate to Severe Cases

More severe cases need to be treated with antibiotics which are effective against this bacteria. Usually this will be metronidazole or vancomycin. Symptoms should subside after about 3 days but a full recovery will take 7-10 days. Fluid replacement may be necessary to treat or prevent dehydration.

Relapses

Unfortunately in a quarter of cases a relapse will occur and this can be more difficult to treat. Symptoms return within about a week of completing the treatment.

After a first relapse the original treatment regime will usually be repeated but if this does not work then additional newer antibiotics such as fidaxomicin or rifaximin will be added.

Unfortunately a percentage of sufferers will go on to develop chronic CDI and other treatment options will need to be tried. My advice is to ask to see a specialist in this area.

Sometimes probiotics are used in conjunction with antibiotics to try and boost the levels of ‘good’ bacteria in the gut, but the jury is out as to whether this therapy really works once the  C. diff infection is established.

Immunoglobulins are sometimes injected or used intravenously.

Fecal transplant is another option. (Other names include: Fecal Microbiota Transplantation (FMT), Fecal Bacteriotherapy, Restoration of Human Bowel Flora and Human Probiotics Infusion)

This involves getting a fecal sample from a healthy, screened donor (often a family member) which is then made into a diluted solution with sterile saline and introduced into the ill person’s bowel either via nasojejunal tube (a tube running through the nose to the intestine), via colonoscopy under sedation or via enema. This introduces healthy, good bacteria which can fight the infection.

The success rate in chronic cases is approximately 90% compared to 30%+ for antibiotics.

Although fecal transplant therapy has been around since 1958 it has not been very popular as many people find it difficult to get around their distaste for having someone else’s feces introduced into their body. It is not very easy to find a doctor who will perform this procedure.

The FDA in the USA have in the past made it extremely difficult to perform this procedure by requiring doctors to get their approval before every case. However, they have just announced (June 2013) that in future they are going to make it easier and doctors will not have to seek permission to carry out this treatment for people with conventional treatment resistant CDI.

Of American hospital stays 0.9% are related to C. diff infections (2009); these people will now have a better chance of a cure. 

New Treatments

Nitazoxanide - This treatment was first developed in the 1980s to combat intestinal parasites but it has recently been found to be effective for some people against CDI usually in conjunction with other drugs.

Lactobacillus GG - This probiotic can suppress C. diff infections if used in high doses and for a prolonged time. Used in conjunction with appropriate antibiotics it has sometimes been curative. It is sold in the US as Culturelle.

Clostridium butyricum (strain Myiari CBM 588) - This clostridium is a friendly type which can live in the bowel without causing any problems. It has been found that it inhibits the growth of C. diff infections.

It is a type of probiotic which has been used in Japan since the 1960s and is routinely given to hospital patients there before or shortly after admission especially if they are expected to take antibiotics. This is in order to prevent infection with C. diff taking hold.

The Myarisian Pharmaceutical Company Ltd which manufactures it, is applying for a license to sell it as a novel food (expected to be called Miya-Pro) in Europe (2013). In the US clinical trials are under way (2013) at Osel Inc, Mountain View, CA to develop a product for sale there.

Cholestyramine (Questran) and Colestid granules - The toxins produced during a CDI bind to these bile acid sequestrant granules and so they reduce the symptoms of diarrhea and cramping. They are not a cure but can be useful in providing symptomatic relief and in conjunction with vancomycin have been successful in resolution of infections.

Complications

  • This infection can lead to severe dehydration and kidney failure.
  • Perforation of the bowel and peritonitis.
  • Pseudomembranous colitis; results from an inflammatory reaction to the toxins released by the bacteria. White membrane like plaques form on the bowel wall.
  • Toxic Megacolon, where gas builds up, resulting in life-threatening severe swelling of the bowel.
  • Colectomy (surgical removal of the colon as a treatment). This does not always help, as the bacteria can remain, the death rate is very high and fecal transplantation will no longer be possible.
  • Death

My Experience with CDI

Luckily for me I have not actually suffered with a C. diff infection myself but I helped care for my sister when she contracted this nasty infection. We were all very happy as she had been called up to a well-known hospital to have a kidney transplant. She had been waiting many years as she could not have one from the family as she has a genetic condition.

The operation had gone well but only two days after being admitted she started suffering with terrible diarrhea, abdominal cramps and fever. She was diagnosed with CDI; a very worrying and dangerous diagnosis when she was taking immunosuppressant drugs to stop her new kidney rejecting!

Unfortunately the hospital had not been renovated for a while as they were spending the budget building a brand new hospital next door and I could see that it was difficult to keep the aging infrastructure, old equipment and cracked floors clean.

What to do? I knew that the only thing which would kill the bacteria and spores which by this time must have been on every surface in her room was bleach, so I took myself off to the local hardware store and stocked up on bleach, gloves, a bucket and disposable cleaning cloths.

I then cleaned down every surface and piece of equipment with dilute bleach every day when I visited. “You can’t do that” she said “you will get into trouble” but do you know, not one person said a thing to me even though they could see what I was doing. They knew that they were not keeping the place clean.

The cleaning routine they had of cleaning the sink, the mirror and sweeping the floor was not going to achieve anything. Of course my sister was being treated by the medical staff with strong antibiotics but I like to think that I helped prevent her becoming re-infected.

If you are looking for information about other causes of diarrhea please browse this site and for more information about treatment of C. diff please read the next article.


C. Diff Infection - How to Beat It

C. diff infection is hard to beat. Find information here about the latest treatments.

Go to C. Diff Infection - How to Beat It

Return to Diarrheanurse Homepage from C. Diff


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