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What it is

Clostridioides difficile [klos-TRID-e-OY-dees dif-uh-SEEL], formerly known as Clostridium difficile and often called C. difficile or C. diff, is a bacterium (germ) that causes diarrhea and colitis. Colitis is an inflammation of the colon.

By the numbers

Symptoms

Complications

Common

Dehydration

Inflammation of the colon, known as colitis

Rare

Serious intestinal condition, such as toxic megacolon

Sepsis, the body's extreme response to an infection

Death

Risk factors

Who is at risk

While C. diff infection can affect anyone, most cases occur when you've been taking antibiotics or soon after you've finished taking antibiotics. People are up to 10 times more likely to get C. diff infection while taking an antibiotic or during the three months after, with longer courses potentially doubling their risk.

Other risk factors

Older age (65 or older)

Recent stay at a hospital or nursing home

A weakened immune system, such as organ transplant patients taking immunosuppressive drugs or people with HIV/AIDS or cancer

Previous infection with C. diff or known exposure to the germs

Keep in mind

Environmental risk factors

C. diff infection is more common among patients in healthcare settings, such as hospitals and nursing homes. This is because many people carrying C. diff stay or get treated in those facilities.

Causes and spread

C. diff germs spread from person to person in poop, but the bacteria are often found in the environment. Finding C. diff germs in the home is not unusual, even when no one in the home has been ill with C. diff infection.

When C. diff germs are outside the body, they become spores. These spores are an inactive form of the germ and have a protective coating allowing them to live for months or years on surfaces and in the soil. The germs become active again when you swallow these spores and they reach the intestines.

Healthy people don't get infected often even if the spores reach their intestines. If your immune system is weak or you've recently taken antibiotics, you could get sick. Taking antibiotics can affect your microbiome, making you more susceptible to illnesses like C. diff infection.

The microbiome

The microbiome is the neighborhood of good and bad germs that live in or on your body-including your stomach and intestines, your mouth, your urinary tract, and on your skin. Some of those germs can cause illness, but others are very important in keeping you healthy.

Microbiomes and C. diff

A healthy microbiome helps protect you from infection (like C. diff), but antibiotics disrupt your microbiome. Antibiotics that fight bacterial infections by killing bad germs can also get rid of the good germs living in the digestive tract that protect the body against infections. The effect of antibiotics can last as long as several months. If you come in contact with C. diff germs during this time, you can get sick.

Prevention

Any time antibiotics are used, they can cause side effects, including C. diff infection. Take antibiotics only when you need them. Talk to a healthcare professional about the best treatment for your illness.

Reduce the spread of C. diff by washing your hands with soap and water after using the bathroom and before you eat. You can take steps to reduce your risk of C. diff infection.

Diagnosis

If a healthcare professional suspects C. diff infection, they will review your symptoms and order a lab test of a stool (poop) sample.

Developing diarrhea is common while on or after taking antibiotics. Only in a few cases is that diarrhea caused by C. diff infection. If your diarrhea is severe, do not delay getting medical care.

When immediate care is needed

Treatment and recovery

Treatment for C. diff infection usually involves taking a specific antibiotic such as vancomycin or fidaxomicin for at least 10 days.
If you were taking an antibiotic for another infection, a healthcare professional might ask you to stop taking it if they think it's safe to do so.

The healthcare team might admit you to the hospital. In this case, they will use certain precautions, like wearing gowns and gloves to prevent the spread of C. diff infectionto themselves and other patients.

Reinfection

Some people get C. diff infection over and over again.

If you start having symptoms again, seek medical care.

For those with repeat infections, innovative treatments, including fecal microbiota transplants, have shown promising results.

What CDC is doing

CDC works with both federal and public health partners to reduce C. diff infections.

C. diff infections are an urgent problem in hospitals, nursing homes, and in communities. CDC is involved in education, research, and tracking and reporting efforts to reduce C. diff infections.

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Basic information about Clostridioides difficile, often called C. difficile or C. diff.

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Clostridioides Difficile, also known as C. diff or Clostridium diffiicle, is a gram-positive, spore-forming, rod shaped bacterium that causes diarrhea and inflammation within the colon. It spreads from person to person through feces. Most of the cases are of individuals that have been taking antibiotics or recently finished taken them.

Individuals are 10 times more liked to get C. diff during the time they are taking antibiotics or the three months after. C. Diff is also commonly seen in hospital or nursing home setting but is not limited to these areas. Those with weakened immune systems, are older than 65, or have previous exposure are also at higher risk.

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Clostridium difficile bacilli

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Some of the common symptoms that are connected with an infection of Clostridium difficile are watery diarrhea, fever, loss of appetite, nausea, and abdominal pain.

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In a recently article, a new treatment, SCUT1-2, is a hybrid of the bile acid metronidazole. This new treatment is being tested to allows for the inhibition and kiiling of c. diff in its vegetative form and spore germination. As well as preventing the growth of c. diff cells, the treatment also has less an effect on the gut microbiota.

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Metronidazole-ursodeoxycholic acid bifunctional antibacterial: A promising strategy to combat Clostridium difficile infection and prevent recurrence - PubMed

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Current treatments against Clostridium difficile infection (CDI), such as vancomycin and metronidazole, frequently lead to severe recurrence due to disruption of gut microbiota balance, which results in a pressing need for new chemical entities to treat CDI. Bile acids, such as UDCA, have been demon …

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1. Implementing infection control measures

2. Discontinue causative antibiotics

3. Administer appropriate medications bases on guidelines

4. Screen patients with diarrhea for c. diff

5. Stool transplantation (fecal bacteriotherapy)

6. Isolation and hygiene

7. Probiotics

More info

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Laboratory tests can be done that can detect causative organisms (bacterial culture, antigen detection), or toxins (PCR data) with one's stool.

Example of lab tests:

1. Toxin detection EIA: relatively simple and less espensive than PCR

2. Molecular tests: detects the gene encoding toxin B that are highly sensitive (preferred test)

3. Tissue cytotoxin assay: Test is more sensitve than EIAs, slow turnover rate.

4. Stool culture

5. Antigen detection

It can also be a suspected diagnosis if an individual presents with diarrhea and also received antibiotic in the last 2 months.

(more here)

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Source

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An inflammatory bowel disease (IBD) physician at Massachusetts General Hospital, and instructor at Harvard Medical School. She also specializes in research within ulcerative colitis, Crohn's disease and microscopic colitis.

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Find a Researcher - Massachusetts General Hospital

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Kristin Burke, M.D. | Mass General Research Institute

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Dr. Kristin Burke, MD, MPH is an inflammatory bowel disease physician in the Crohn’s and Colitis Center in the Division of Gastroenterology at Ma…

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Cliff and C. diff - Smelling the diagnosis

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Complications that relate to C. Diff include:

Common Complications

Dehydration

Colitis (Inflammation of colon)

Rare Complication

Serious Intestinal conditions, like megacolon

Sepsis

Death