What Causes Clostridioidesdifficile
When a person takes antibiotics, the good germs in the intestines are killed off making it easier to become infected by the Clostridioidesdifficile germ. The germ is found in stool , and is spread to other people by unwashed hands, contaminated surfaces, or objects.
In a healthcare setting, the germs have been found on objects such as toilets, bathroom fixtures, bed rails, and rectal thermometers. The germ is able to survive for a very long time on a variety of surfaces.
Causes And Risk Factors
What causes C. diff? A C. diff infection is caused by C. difficile bacteria, which can be found in several common places, including human and animal feces as well as soil, air and water. The bacteria can also be found in some foods such as processed meat. The human intestines have somewhere around 100 trillion bacterial cells and up to 2,000 different kinds of bacteria. Much of this bacteria is good because it keeps possibly problematic bacteria in check and guards the body against infection. According to Mayo Clinic, A small number of healthy people naturally carry the bacteria in their large intestine and dont have ill effects from the infection.
So when does C. diff bacteria become problematic and also symptomatic? Its when C. diff is not kept under control and begins to overgrow. Antibiotics are the most common reason this can occur, since antibiotics not only kill the bacteria they are aiming to kill, but also all the good bacteria as well. Antibiotics that most commonly lead to this type of infection include fluoroquinolones, penicillins, cephalosporins and clindamycin.
- Abdominal surgery that requires moving the intestines aside
- Living in a nursing home or extended-care facility
- Colon health issues, such as inflammatory bowel syndrome or colorectal cancer
- Having a weakened immune system
- Previous C. diff infection
- Being 65 years of age or older
What Are The Most Dangerous Complications Of C Diff Colitis
Its important to seek medical care early in C. diff. The infection can progress quickly and lead to dangerous complications that can lead to death. Complications include:
Dehydration: Frequent episodes of diarrhea can cause dehydration. Its important to take in plenty of fluids during this time to stay hydrated.
: Sepsis is a whole body reaction to infection. Its a life-threatening medical emergency, and treatment aims to control the infection.
Kidney failure: Severe dehydration can cause the kidneys to stop working properly.
Respiratory failure: This is a common complication of sepsis. This is where the lungs cant properly provide oxygen for the body.
Toxic megacolon: When the colon becomes very infected or inflamed, it cant pass gas and stool. This leads to swelling of the colon and may need surgery to prevent further problems.
Colon rupture: If the colon swells too much, the colon wall can rupture. This causes fecal matter and bacteria to leak into the belly. Its a medical emergency that typically needs emergency surgery.
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What Did Researchers Find About Probiotics
The chart below lists some different types of probiotics and what researchers found about each.Findings About Probiotics
|What did researchers find?|
|Saccharomyces boulardii||Does not appear to help keep CDI from coming back when added to treatment with an antibiotic, but more research is needed to know this for sure.|
|Lactobacillus||Appears to help keep CDI from coming back when added to treatment with an antibiotic, but more research is needed to know this for sure.|
|A combination of two or more types of probiotics||Appears to help keep CDI from coming back when added to treatment with an antibiotic, but more research is needed to know this for sure.|
How Does It Spread
The C. diff bacterium comes from feces. You can develop an infection if you touch a contaminated surface and then touch your mouth.
In addition, the spores of C. diff are resistant to many chemicals used for cleaning. As a result, they can stick around for a long time.
While anyone can develop a C. diff infection, some people have an increased risk.
Things that can increase your risk include:
- taking antibiotics, especially a long course of broad spectrum antibiotics
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Ancient Remedy A Promising Cure For Clostridium Difficile
A team of researchers at the U of M have revived an ancient medical treatment to address a severe gastrointestinal illness and have developed ways to standardize the procedure.
The process, dubbed fecal microbiota transplantation transfers healthy bacteria from one persons intestine to another person where the healthy bacteria have been depleted. Its very effective for people suffering from Clostridium difficile, also called C. diff, an opportunistic pathogen that takes over when antibiotics wipe out essential and symbiotic bacteria in the gut.
Although the infection itself is triggered by antibiotics, the standard treatment for C. diff has been to give even more antibiotics, which can trigger a vicious cycle of recurrent C. diff. Normally, C. diff can be held at bay by resident bacteria in the colon. When antibiotics kill off the normal bacteria, C. diff flourishes, releasing toxins that cause diarrhea, fever, nausea and abdominal pain. Subsequent courses of antibiotics suppress, but dont kill C. diff, and it often reemerges. In severe cases, patients can waste away and die.
Clostridioides Difficile Infection: Update On Management
ANNE MOUNSEY, MD KELLY LACY SMITH, MD and VINAY C. REDDY, MD, MPH University of North Carolina School of Medicine, Chapel Hill, North Carolina
SARAH NICKOLICH, MD, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
Am Fam Physician. 2020 Feb 1 101:168-175.
Patient information: A handout on this topic is available at .
Clostridioides difficile is an anaerobic, spore-forming, gram-positive bacillus identified in 1978 as the primary cause of antibiotic-associated diarrhea and pseudomembranous colitis.1 The rate of C. difficile infections increased from 13 to 14.2 cases per 1,000 adults between 2011 and 2015 it is now the most commonly reported nosocomial pathogen in the United States.2 Health care costs associated with C. difficile infection were estimated at $4.8 billion for acute care facilities in 2008.3 This article discusses recently updated guidelines for the diagnosis and treatment of C. difficile infection.
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How Is Clostridium Difficile Treated
Fortunately, there are a few antibiotics that act specifically against C. difficile and these can be used to treat infected people. In about 20% of the cases however, the infection may relapse, meaning that it returns after treatment. Sometimes multiple relapses may occur . The main way to help people with relapsing C. difficile is to restore their normal colonic flora. This can be done with probiotics, for example. Probiotics are pills or capsules containing microorganisms that have been selected and grown in laboratories because they are known to grow well in the intestines and can restore normal colonic flora.
A few years ago, a doctor had a different idea for restoring the colonic flora of a patient suffering relapsing C. difficile diarrhea. Why not restore the damaged colonic flora with the help of the flora from a healthy person who has not taken antibiotics? A team of doctors in the Netherlands did this and it worked! They took 250 g of feces from a healthy person and diluted it in water. Then, they inserted it into the patients intestines with a tube called a catheter. Most patients were cured! So now we know that fecal transplant is an effective technique for treating patients with relapsing C. difficile diarrhea.
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If C Diff Is Caused By Antibiotics How Do Antibiotics Treat It
Not everyone who has this infection needs treatment. About 20% of patients see their symptoms disappear just a few days after they stop taking the antibiotic that caused it in the first place. The other 80% need active treatment.
It may seem odd to treat a condition caused by antibiotics with more antibiotics, but since Clostridioides difficile is a bacterium, antibiotics are the only way to treat the infection. At this point, there are only two effective antibiotics, vancomycin or fidaxomicin.
Researchers are looking at a newer treatment called fecal transplantation or bacteriotherapy. Stool from a healthy person is collected and inserted into the infected patients colon, much like a colonoscopy. Another approach is to place the stool in capsules, which the patient swallows.
Fecal transplant is not completely new some hospital systems have been using the treatment since 2012. However, its understandable that a patient may be wary about the procedure, as it is out of the norm. However, a study published in 2013 in the New England Journal of Medicine showed that this approach was more effective than the antibiotic vancomycin in treating repeat C. difficile infection.
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How You Get Clostridium Difficile
C. diff bacteria are found in the digestive system of about 1 in every 30 healthy adults.
The bacteria often live harmlessly because other bacteria normally found in the bowel keep it under control.
But some antibiotics can interfere with the balance of bacteria in the bowel, which can cause the C. diff bacteria to multiply and produce toxins that make the person ill.
When this happens, C. diff can spread easily to other people because the bacteria are passed out of the body in the personâs diarrhoea.
Once out of the body, the bacteria turn into resistant cells called spores.
These can survive for long periods on hands, surfaces , objects and clothing unless theyâre thoroughly cleaned, and can infect someone else if they get into their mouth.
Someone with a C. diff infection is generally considered to be infectious until at least 48 hours after their symptoms have cleared up.
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What Is A C Difficile Infection
A C. difficile infection results from a type of bacteria called Clostridium difficile infecting your large intestine. C. difficile bacteria are common and can be found everywhere. These bacteria can be found in the air, in water, or on items such as door knobs, sinks, and countertops. Small amounts of C. difficile bacteria are even found in many people’s intestines.
If C. difficile bacteria in your intestines grow out of control, they can cause an infection. This can happen after a person takes antibiotics. Antibiotics are a type of medicine that fight infections caused by bacteria. When you take antibiotics, the normal bacteria in your intestines that help keep you healthy can also be killed. When this happens, bacteria such as C. difficile can grow out of control. When a person has CDI, chemicals called toxins produced by the C. difficile bacteria make him or her sick.
CDI affects about 500,000 people in the United States each year. CDI can be mild to severe. The most common symptoms of CDI include watery diarrhea and cramping in your belly. Some people with CDI can become very sick. In rare cases, severe CDI can be life threatening.
Symptoms of severe CDI may include:
- Having watery diarrhea often throughout the day and night
- Cramping and pain in your belly that may be severe
- Blood or pus in your bowel movements
- Tenderness in your belly
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Clostridium Difficile In Hospitals
As mentioned earlier, in most cases if you encounter C. difficile in your meal nothing will happen except if you have recently taken antibiotics. Without your protective colonic flora, C. difficile can grow in your intestines, produce a lot of toxins, and cause inflammation and diarrhea . Fortunately, the probability of encountering C. difficile in your food is very low, so the chances of developing C. difficile diarrhea when you take antibiotics are relatively small.
- Figure 3 – When the colonic flora has been damaged by antibiotics, C. difficile has room to multiply.
- The dividing bacteria will produce toxins that damage the intestinal cells and cause diarrhea.
What Increases The Risk Of Cdi
Anyone can get CDI, but some people have a higher risk. You may be at a higher risk for getting CDI if you:
Have taken antibiotics in the past 30 days.
- Have a weak immune system from an ongoing illness.
- Have been in the hospital or a long-term care facility.
- Are age 65 or older.
- Have inflammatory bowel disease.
- Have had CDI one or more times in the past.
- Take a medicine to lower the amount of acid in your stomach, such as Prevacid®, Tagamet®, Prilosec®, or Nexium®. These medicines are called proton pump inhibitors or PPIs.
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Who’s Most At Risk Of C Difficile
C. difficile mostly affects people who:
- have been treated with broad-spectrum antibiotics or several different antibiotics at the same time, or those taking long-term antibiotics
- have had to stay in a healthcare setting, such as a hospital or care home, for a long time
- are over 65 years old
- have certain underlying conditions, including inflammatory bowel disease , cancer or kidney disease
- have a weakened immune system, which can be because of a condition such as diabetes or a side effect of a treatment such as chemotherapy or steroid medication
- are taking a medication called a proton pump inhibitor to reduce the amount of stomach acid they produce
- have had surgery on their digestive system
Many C. difficile infections used to occur in places where many people take antibiotics and are in close contact with each other, such as hospitals and care homes.
However, strict infection control measures have helped to reduce this risk, and an increasing number of C. difficile infections now occur outside these settings.
What Can Be Done To Prevent The Spread Of C Difficile
As with any infectious disease, frequent hand hygiene is the most effective way of preventing the transmission of healthcare associated infections. Hand washing with soap and water is important during C. difficile outbreaks and is one of the best defences against further spread of the bacteria.
If you do not have access to soap and water, frequent use of alcohol-based hand rubs is encouraged. Most healthcare facilities provide alcohol-based hand rubs at entrances. Be sure to use them, but be aware that they are less effective than washing with soap and water as they do not destroy C. difficile spores.
If you work in or visit a hospital or long-term healthcare facility, wash your hands often preferably with soap and water, especially after using the toilet. Gloves should be worn when caring for a patient with C. difficile infection or if in contact with his/her environment. Use a new pair of gloves when caring for each patient. Be sure to wash your hands with soap and water after removing your gloves.
When antibiotics are prescribed, follow your doctor, pharmacist, or healthcare providerÃ¢s instructions and the directions on the label. Keep taking the antibiotics as prescribed to kill all of the C. difficile bacteria.
If you have concerns about C. difficile and medication you are currently using, talk to your doctor, pharmacist, or healthcare provider.
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Passive Immunization: Intravenous Antibodies
Intravenous immunoglobulin products contain neutralizing levels of IgG against C. difficile toxins A and B, albeit at varying levels. The role of IVIG for CDI has only been assessed in several small uncontrolled, nonrandomized, retrospective studies. Among 11 small case reports and case series of patients with CDI, 40 of 46 patients receiving a wide variety of IVIG dosing regimens had clinical resolution of diarrhoea and 14% had a recurrence of the infection. However, because IVIG has not been assessed in a clinical trial at this time, convincing evidence of clinical efficacy of IVIG for CDI is lacking.
How Is A Cdi Diagnosed And Treated
A bowel movement sample may be sent to a lab to be tested for C. diff. The goal of treatment is to restore the healthy balance of bacteria to your colon. This should help stop your diarrhea.
- Antibiotics help treat or prevent an infection caused by bacteria. If antibiotics caused your CDI, you may need to stop taking them and switch to a different antibiotic.
- Immune globulin medicine may help treat severe or frequent CDI. You may need it to help your immune system fight infection.
- Surgery may be needed if your CDI is severe or damaged your colon. During surgery, part of your colon is removed.
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What Is The Source Of This Information
This information comes from a research report that was funded by the Agency for Healthcare Research and Quality, a Federal Government agency.
To write the report, researchers looked at 56 scientific research articles reporting on studies to prevent and treat CDI. The studies were published through April 2015.
Health care professionals, researchers, experts, and the public gave feedback on the report before it was published.
Can C Diff Go Away Without Treatment
Asymptomatic C diff infections usually go away without intervention. When a C diff infection becomes symptomatic, one in every five infections resolves without the need for medication. C diff bacteria cannot grow in the air, but they can survive in the environment for long periods by transforming into spores.
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Tip #: Limit Close Contact With Others
Like we mentioned in Tip #7, contact precautions are used in the hospital when a C. diff infection is severe. While you may not have a severe diarrhea infection, protect yourself and others by staying home. Take a sick day at work or keep your child home from school so that the infection does not spread. Besides, no one wants to be at work or school with diarrhea!
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