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Clostridium difficile

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Clostridium difficile
Clostridium difficile is a rod-like bacterium
Scientific classification
C. difficile
Binomial name
Clostridium difficile
Hall & O'Toole, 1935

Clostridium difficile is a species of bacteria. It is often called C. diff (pronounced "see diff"). It is a gram-positive bacteria which belongs to the genus Clostridium.[1]

C. diff can live in the human colon (the large intestine) without causing any problems. About 2-5% of adults have C. diff living in their colons.[1] However, in some people, C. diff causes serious illness. In these people, C. diff bacteria grow out of control in the colon.[2] The bacteria attack the lining of the intestines. This causes a problem called C. diff colitis. Colitis is inflammation (swelling) of the colon.[1]

C. diff infection is getting more and more common in hospitals, nursing homes, and other health care facilities.[3] It kills about 14,000 people a year just in the United States.[3][4]

C. diff infection[change | change source]

The most common symptom of C. diff infection is severe diarrhea.[5] C. diff infection can also cause fever, belly pain, loss of appetite (not wanting to eat), and nausea.[5][6]

Some cases of C. diff infection are not very serious. In other cases, people get very sick and even die.[6] When people experience severe diarrhea from C. diff infection, they may become badly dehydrated (not have enough fluid in their bodies). This can damage the kidneys leading to renal failure. C. diff bacteria can also eat a hole in the intestines (perforation), which is very dangerous.[6]

Once a person has C. diff infection, they can spread the infection to other people. C. diff can live for a long time on surfaces like doorknobs, sheets, and medical equipment. If a person with C. diff infection does not clean their hands, they can spread the bacteria to other people on their hands.[7]

Who gets C. diff infection?[change | change source]

C. diff infection usually happens in people who are taking antibiotic medicine.[8][9][10] Usually, the intestines are filled with good, healthy bacteria. These healthy bacteria keep C. diff bacteria under control. If antibiotic medicines kill the healthy bacteria, C. diff bacteria can grow out of control.[2]

C. diff infection is also more common in:

  • People in hospitals, nursing homes, and other health care facilities[4]
  • People who are 65 years old or older
  • People with weak immune systems (in the body, the immune system is in charge of fighting disease)
  • People who have just had surgery on their intestines
  • People with colon problems, like inflammatory bowel disease or colon cancer
  • People who take antacid medicines called proton pump inhibitors. (These medicines cause the stomach to make less acid. Normally, stomach acid helps keep bacteria like C. diff under control.)[11][12]

How is C. diff infection treated?[change | change source]

C. diff infection can be treated with some antibiotic medicines.[13] However, C. diff is an antibiotic-resistant bacteria. This means that many antibiotic medicines cannot kill C. diff. This can make C. diff infection very difficult to treat. Many people with C. diff infection have relapses (they get better for a while, but then get sick again). This happens to about one in every five people with C. diff infection.[14]

Usually, doctors try an antibiotic called metronidazole as the first treatment for C. diff infection.[13] About three in every four people with C. diff infection get better after taking metronidazole for ten days.[13][15] When metronidazole does not work, doctors give other antibiotics, usually vancomycin or fidoxamacin.[13]

In severe cases of C. diff infection which do not get better with antibiotics, doctors may do surgery to remove parts of the colon.[7]

Fecal transplantation, especially for those with recurrent C. diff infections, has been shown to be more effective than oral vancomycin.[16]

How can C. diff infection be prevented?[change | change source]

Usually, C. diff infection can be prevented. Hand-washing is one of the best ways to prevent C. diff infection.[7][17] If a person has C. diff bacteria on their hands, they can kill the bacteria by washing their hands with soap and water.[17] C. diff bacteria on surfaces (like doorknobs and medical equipment) can be killed with bleach. Many hospitals and other health care facilities have special bleach wipes which kill C. diff. Washing sheets and clothes with bleach and detergent also kills C. diff.[7]

Alcohol does not kill C. diff, so instant hand sanitizer and alcohol wipes will not keep C. diff bacteria from spreading.[7][18]

Hospitals and other health care facilities can also use "C. diff precautions" to prevent C. diff from spreading.[7][17] (Precautions are ways of being careful.) When a patient has C. diff, health care workers can keep the bacteria from spreading by:

  • Using gloves and then washing their hands every time they touch the patient, the patient's things, or anything in the patient's room
  • Cleaning medical equipment with special bleach wipes every time they use it
  • Cleaning the patient's things and the patient's room with bleach
  • Giving patients with C. diff infection private rooms, or putting them only with other patients who have C. diff infection[17][19]

References[change | change source]

  1. 1.0 1.1 1.2 Moreno, Megan A.; Furtner, Fred; Rivara, Frederick P. (2013-06-01). "Clostridium difficile: A Cause of Diarrhea in Children". JAMA Pediatrics. 167 (6): 592. doi:10.1001/jamapediatrics.2013.2551. ISSN 2168-6203. PMID 23733223.
  2. 2.0 2.1 Curry J (2007-07-20). "Pseudomembranous Colitis". WebMD. Retrieved 2008-11-17.
  3. 3.0 3.1 "Bugs in the system". The Economist. 3 November 2012.
  4. 4.0 4.1 Clabots, C. R.; Johnson, S.; Olson, M. M.; Peterson, L. R.; Gerding, D. N. (1992-09-01). "Acquisition of Clostridium difficile by Hospitalized Patients: Evidence for Colonized New Admissions as a Source of Infection". Journal of Infectious Diseases. 166 (3): 561–567. doi:10.1093/infdis/166.3.561. ISSN 0022-1899. PMID 1323621.
  5. 5.0 5.1 Joshi NM, Macken L, Rampton D (2012). "Inpatient diarrhoea and Clostridium difficile infection". Clinical Medicine. 12 (6): 583-588.
  6. 6.0 6.1 6.2 Katz, David A.; Lynch, Mary E.; Littenberg, Benjamin (May 1996). "Clinical prediction rules to optimize cytotoxin testing for Clostridium difficile in hospitalized patients with diarrhea". The American Journal of Medicine. 100 (5): 487–495. doi:10.1016/S0002-9343(95)00016-X. PMID 8644759.
  7. 7.0 7.1 7.2 7.3 7.4 7.5 Centers for Disease Control (2014-07-09). "Clostridium difficile infection". Retrieved 2014-12-29.
  8. Baxter, Roger; Ray, G. Thomas; Fireman, Bruce H. (January 2008). "Case-Control Study of Antibiotic Use and Subsequent Clostridium difficile– Associated Diarrhea in Hospitalized Patients". Infection Control & Hospital Epidemiology. 29 (1): 44–50. doi:10.1086/524320. ISSN 0899-823X. PMID 18171186. S2CID 39290661.
  9. Gifford AH, Kirkland KB (December 2006). "Risk factors for Clostridium difficile-associated diarrhea on an adult hematology-oncology ward". European Journal of Clinical Microbiology & Infectious Diseases : Official Publication of the European Society of Clinical Microbiology. 25 (12): 751–5. doi:10.1007/s10096-006-0220-1. PMID 17072575. S2CID 23822514.
  10. Palmore, Tara N.; Sohn, SeJean; Malak, Sharp F.; Eagan, Janet; Sepkowitz, Kent A (August 2005). "Risk Factors for Acquisition of Clostridium difficile –Associated Diarrhea among Outpatients at a Cancer Hospital". Infection Control & Hospital Epidemiology. 26 (8): 680–684. doi:10.1086/502602. ISSN 0899-823X. PMC 5612438. PMID 16156323.
  11. Howell, Michael D. (2010-05-10). "Iatrogenic Gastric Acid Suppression and the Risk of Nosocomial Clostridium difficile Infection". Archives of Internal Medicine. 170 (9): 784–790. doi:10.1001/archinternmed.2010.89. ISSN 0003-9926. PMID 20458086.
  12. Deshpande, Abhishek; Pant, Chaitanya; Pasupuleti, Vinay; Rolston, David D.K.; Jain, Anil; Deshpande, Narayan; Thota, Priyaleela; Sferra, Thomas J.; Hernandez, Adrian V. (March 2012). "Association Between Proton Pump Inhibitor Therapy and Clostridium difficile Infection in a Meta-Analysis". Clinical Gastroenterology and Hepatology. 10 (3): 225–233. doi:10.1016/j.cgh.2011.09.030. PMID 22019794.
  13. 13.0 13.1 13.2 13.3 Drekonja, Dimitri M.; Butler, Mary; MacDonald, Roderick; Bliss, Donna; Filice, Gregory A.; Rector, Thomas S.; Wilt, Timothy J. (2011-12-20). "Comparative Effectiveness of Clostridium difficile Treatments: A Systematic Review". Annals of Internal Medicine. 155 (12): 839–847. doi:10.7326/0003-4819-155-12-201112200-00007. ISSN 0003-4819. PMID 22184691. S2CID 8774291.
  14. Ryan KJ; Ray CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. pp. 322–4. ISBN 0-8385-8529-9.
  15. Surawicz, Christina M; Brandt, Lawrence J; Binion, David G; Ananthakrishnan, Ashwin N; Curry, Scott R; Gilligan, Peter H; McFarland, Lynne V; Mellow, Mark; et al. (26 February 2013). "Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections". The American Journal of Gastroenterology. 108 (4): 478–498. doi:10.1038/ajg.2013.4. PMID 23439232. S2CID 54629762.
  16. Day, Jo Ann (4 April 2022). "Fecal Transplantation (Bacteriotherapy) - Johns Hopkins Division of Gastroenterology and Hepatology". www.hopkinsmedicine.org.
  17. 17.0 17.1 17.2 17.3 "Clostridium difficile prevention". Mayo Clinic. Mayo Foundation for Medical Education and Research. July 16, 2013.
  18. "Cleaning agents 'make bug strong'". BBC News Online. 2006-04-03. Retrieved 2008-11-17.
  19. Savidge, Tor C; Urvil, Petri; Oezguen, Numan; et al. (September 2011). "Host S-nitrosylation inhibits clostridial small molecule–activated glucosylating toxins". Nature Medicine. 17 (9): 1136–1141. doi:10.1038/nm.2405. ISSN 1078-8956. PMC 3277400. PMID 21857653.