Antibiotics are medicines used to treat bacterial infections. They do this by prohibiting the bacteria from reproducing or by completely eliminating the bacteria.
But for some people, treatment using antibiotics can expose them to a life-threatening bacterial infection known as Clostridium difficile.
Clostridium difficile, also known as C. diff, is an infection that causes diarrhea and inflammation of the colon- a condition known as colitis.
It is a symptomatic infection caused by the bacterium Clostridioides difficile and characterized by symptoms which include fever, diarrhea, abdominal pain and nausea.
It can sometimes lead to complications, some of which may include toxic megacolon, sepsis, and perforation of the colon.
Clostridium difficile is spread by bacterial spores found in feces. These spores may contaminate surfaces and be further transmitted by healthcare workers.
The use of antibiotics, older age, hospitalization and other health-related issues may put one at risk of getting infected with the bacteria.
To diagnosis C. diff, stool culture of the suspected person would be tested for DNA and toxins of the bacteria. Asymptomatic cases of the condition are known as C. difficile colonization rather than an infection.
Clostridium difficile is a global occurrence, occurring more often in men than in women. The United States recorded about 453,000 cases and 29,000 deaths from the disease in 2011. C. diff bacteria was first discovered in 1935 and confirmed to be disease-causing in 1978.
Although transmission of the bacteria is widespread in hospitals and healthcare centres, the majority of the infections are acquired outside hospital settings.
Causes and Risk Factors of Clostridium difficile
According to the American College of Gastroenterology (ACG) between 5 to 15 per cent of healthy adults — and 84.4 per cent of newborns and healthy infants — have Clostridium difficile in their digestive system.
However, other bacteria that live in the digestive system usually keep the amount of C. diff under control. An infection occurs when there’s too much C. diff in your intestines.
Risk factors of the infection include:
- Antibiotics: The use of antibiotics such as fluoroquinolones, cephalosporins, and clindamycin have been associated with the development of the infection. Some studies have suggested that the bacteria can be acquired from livestock that have been routinely treated with antibiotics.
- Age: People who are 65 and above are at an increased risk of developing the infection. A weakened immune system may also contribute to the severity of C. diff.
- Hospital exposure: Hospital environments are common areas when people can get infected with the bacterium. This includes healthcare centres, nursing homes, hospitals and other medical institutions. Individuals can get infected when they touch objects and surfaces that have been contaminated with feces and then touch their mouths. Healthcare workers can potentially and unintentionally spread the bacteria to patients and contaminate objects and surfaces.
Long-term hospitalization or residing in a nursing home within the last year are risk factors for increased colonization.
Other risk factors of Clostridium difficile are:
- Having gastrointestinal surgery
- Having chronic kidney or liver disorder
- taking proton pump inhibitors (PPIs)
- Prior C. diff infection
Signs and Symptoms of Clostridium difficile
The primary symptom of a C. diff infection is diarrhea. Other symptoms of the disease include:
- Stomach pain or cramps
- Nausea
- Fever
- Dehydration
- Loss of appetite
- Increased white blood cell count
- Swollen abdomen
- Kidney failure
- Rapid heart rate
- Blood in the stool (in severe cases)
Symptoms of C. diff infection can range from mild to severe. Watery diarrhea occurring several times a day is one of the many signs of C. diff infection. Diarrhea can occur alongside stomach pain even with a mild infection of C. diff.
In more severe cases, there may be blood in the stool. Call a doctor if you notice you are having diarrhea three or more times a day that persists after three days.
You should also seek medical attention if you have abdominal cramps or notice stool in your blood.
Diagnosis of Clostridium difficile
Diagnosis of the infection would involve a doctor asking questions of the symptoms and medical history. They may also order an examination of the patient’s stool sample to analyze it for toxins and DNA of C. diff bacterium.
For severe cases of the disease, the doctor may perform a procedure known as sigmoidoscopy, which involves inserting a sigmoidoscope into the colon to check for signs of inflammation.
Complications
Complications of C. diff infection include:
- Dehydration: Severe diarrhea can lead to loss of fluids and electrolytes, making it difficult for your body to function properly. It can also cause blood pressure to drop to dangerously low levels.
- Kidney failure: Dehydration can occur so rapidly in some causes that kidney function quickly deteriorates.
- Toxic megacolon: A rare condition where the colon is unable to expel gas and stool, causing it to become considerably bloated (megacolon). If left untreated, the colon may rupture and cause the bacteria from the colon to enter your abdominal cavity. This requires immediate attention and could be fatal if left untreated.
- Bowel perforation: Although rare, C. diff may lead to extensive damage of the lining of the large intestine. A hole in the bowel can spill bacteria from the intestine into the abdominal cavity. This could lead to a life-threatening infection called peritonitis.
- Death: C. difficile infections can quickly become fatal if not treated promptly.
Treatment
C. diff can be treated using antibiotics. Some common antibiotics used to treat C. diff infections include:
- Metronidazole (Flagyl)
- Fidaxomicin (Dificid)
- Vancomycin (Firvanq)
The Centers for Disease Control and Prevention (CDC) recommends taking an antibiotic course for at least 10 days to treat a C. diff infection.
For someone with a chronic case of C. diff who’s had at least two cases occurring after the first episode of the infection, a fecal microbiota transplant may be used as a potential treatment option, after antibiotic therapy.
It is necessary that the patient has plenty of fluids to drink as having diarrhea often leads to dehydration, it is therefore important to replenish lost fluid. The patient may require intravenous fluid to treat dehydration in more severe cases.
Surgery may also be necessary to remove the affected parts of the colon.
Prevention
The following are steps you can take to prevent getting infected by C. diff. These include:
- Wash hands regularly with soap and warm water, especially after using the bathroom and before eating.
- Avoid the unnecessary use of antibiotics.
- Keep surfaces in high-use areas clean. This includes bathrooms and kitchens. Try to clean these areas with products containing bleach periodically. Bleach is an effective agent against the C. diff bacterium.
- Request that all medical appliances be thoroughly sanitized before being brought into your room.
