• Clostridium difficile Infection

    C diff Infection

    Definition

    Clostridium difficile (C diff) infection starts in the intestine and is caused by a specific bacteria. In some people, the infection causes symptoms, such as diarrhea. In others it can cause severe illness.
    The Intestines
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    Causes

    The infection is caused by the C diff bacterium. The bacterium makes toxins as it grows. These toxins irritate the intestinal lining, which can lead to swelling and pain.
    The intestines normally have a healthy balance of bacteria that help with digestion. Antibiotics can disturb this balance by killing some bacteria which lets others grow in their place. If C diff is present, it may be able to grow after certain antibiotics.
    C diff can also be picked up in the environment. The bacteria can pass from soiled surfaces to the hands, then to the mouth.

    Risk Factors

    Factors that may increase the chances of infection include:
    • Certain medications, such as antibiotics or proton pump inhibitors
    • Increasing age (> 65 years old)
    • Recent hospital stay
    • Having intestinal diseases
    • History of C diff infection
    • Weakened immune system
    • Poor hygiene, such as lack of proper hand washing

    Symptoms

    In those that have symptoms, they may include:
    • Watery diarrhea—at least 3 times within 24 hours
    • Abdominal pain or cramps
    • Bloating
    • Fever
    • Loss of appetite

    Diagnosis

    The doctor will ask about your symptoms and medical history. A physical exam will be done. A C diff 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
    • Imaging tests:
      • X-rays
      • CT scan

    Treatment

    People with C diff who do not have symptoms do not need treatment. If medications are related to the infection, they can be stopped or changed. Antibiotics are a common problem. Mild infections will usually go away with time. If needed, treatment may include:

    Medications

    C diff is treated with antibiotics. The type depends on how severe the infection is.

    Fecal Microbiota Transplant

    Healthy stool bacteria from a donor is used. This restores a healthy balance of bacteria in the colon.

    Surgery

    Severe or repeated infection may need treatment with surgery:
    • Partial colectomy—The affected part of the colon is removed. The 2 healthy ends of the colon are joined together.
    • Illeostomy with irrigation—The small intestine is brought through the abdominal wall. This opening allows stool to leave the body. A liquid is used to flush the infected part of colon.

    Prevention

    Proper hand washing is the best way to prevent C diff from spreading. Wash your hands with soap and water, especially after using the bathroom. Other preventive methods include:
    • Probiotics—Healthy bacteria can be found in certain foods or supplements.
    • Using medications as prescribed. Do not take antibiotics unless your doctor prescribes them. It is important to take them as instructed.
    • Cleaning surfaces with disinfectants often, especially if someone at home is sick.
    • Making sure any healthcare staff who comes in contact with you washes their hands first.

    RESOURCES

    Centers for Disease Control and Prevention https://www.cdc.gov

    IDSA—Infections Diseases Society of America http://www.idsociety.org

    CANADIAN RESOURCES

    Canadian Association of Gastroenterology https://www.cag-acg.org

    Public Health Agency of Canada http://www.phac-aspc.gc.ca

    References

    C. difficile care at home. C Diff Foundation website. Available at: https://cdifffoundation.org/2014/08/14/c-difficile-care-at-home. Accessed May 11, 2017.

    Clostridium difficile infection. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114378/Clostridium-difficile-infection. Updated February 28, 2017. Accessed May 11, 2017.

    Clostridium difficile infection information for patients. Centers for Disease Control and Prevention website Available at: https://www.cdc.gov/hai/organisms/cdiff/cdiff-patient.html. Updated February 24, 2015. Accessed May 11, 2017.

    Heinlen L, Ballard JD. Clostridium difficile infection. Am J Med Sci. 2010;340(3):247-252.

    Kachrimanidou M, Malisiovas N. Clostridium difficile infection: a comprehensive review. Crit Rev Microbiol. 2011;37(3):178-187.

    Winslow BR, Onysko M, Thompson KA, Caldwell K, Ehlers GH. Common questions about clostridium difficile infection. Am Fam Physician. 2014;89(6):437-442.

    Revision Information

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