Clostridium difficile, known as C. diff or C. difficile, is a bacterium passed from feces. Hand washing and proper hygiene are basic preventive measures against infection, but the bacteria are becoming more common in hospital and nursing home settings. Antibiotic resistance is beginning to appear, with a clindamycin and erythromycin-resistant strain identified in 2000 that has been responsible for epidemic outbreaks in the United States and UK. Untreated C. diff infection can lead to life-threatening colitis.
Clostridium Difficile Infection
C. diff infects the gastrointestinal system, causing inflammation of the colon, called colitis. Symptoms of infection include diarrhea (watery in consistency and occurring at least three times a day for two or more days), loss of appetite, nausea, abdominal pain and tenderness, and fever. Severe and untreated infection can progress to sepsis, a bacterial infection of the blood, which is often fatal. Blood in the watery stool is an indicator of severe infection.
How Clostridium Difficile Spreads
Healthy adults are usually not susceptible to C. diff infection, but the elderly and those in the hospital (particularly those undergoing prolonged antibiotic use) are more at risk for being infected. The bacteria are passed from an infected individual in the feces. Contact with contaminated material and touching the face can then infect another individual. Some spread is via health care workers and in the close space of nursing homes. Some individuals carrying the bacteria do not get sick, but they still spread the pathogen.
The Role of Antibiotics in Clostridium Difficile Illness
C. diff often causes an infection after antibiotic use because the antibiotics kill off much of the natural flora in the intestines. This allows less symbiotic bacteria to grow more readily. There are several strains of bacteria that aid in food digestion and normal body functions, not causing infection as they cooperate with the human body.
Once growing, the Clostridium bacteria produce toxins that destroy the lining of the intestines. The patches of inflammation that result cause the symptoms of infection. When the natural flora returns, the competition keeps the less beneficial bacteria in check. The antibiotic resistant strain of C. diff that emerged in 2000 produces more aggressive toxins, causing disease in healthy adults.
Treatment and Prevention of Clostridium Difficile Infection
C. diff is diagnosed by stool sample testing and is treated by antibiotics, with a normal course lasting at least 10 days. The original antibiotic treatment that triggered the infection is halted first. For resistant strains, different antibiotics may have to be attempted. Probiotics to increase the growth of good bacteria and surgery to remove any heavily damaged portions of the intestine are additional measures that may be taken by a health care provider. Preventing infection is easier than treating it, and previous infections increase the risk of future disease.
Infection is simply prevented by good hygiene:
- Washing hands with warm water and mild soap (not antibacterial soap) after using the restroom and before eating.
- Properly sterilizing hospital instruments and surfaces.
- Health care workers using disposable gloves and instruments.
- Washing household surfaces in the kitchen and bathroom with disinfectants on a regular basis.
- Avoiding unnecessary antibiotic and antibacterial use.
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