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Pathogen Name: Clostridiodes difficile

-In 2016, the species was transferred from the genus Clostridium to Clostridiodes in 2016, thus giving it the binomial Clostridioides difficile. This new name reflects the taxonomic differences between this species and the members of the genus Clostridium.

Disease Name: Clostridium difficile infection (CDI), which causes a number of problems like toxic megacolon and pseudomembranous colitis.

Common Name (everyday language): C. difficile, C. diff, or the Diff

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Name of Pathogen: Clostridiodes (clostridium) difficile

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Name of Pathogen: Clostridiodes (clostridium) difficile

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According to the National Library of Medicine (National Center for Biotechnology Information), the pathogen that causes C. difficile is a Gram-positive, spore-forming, obligate anaerobic bacterium called Clostridium (clostridiodes) difficile.
-This bacterium attacks the gastrointestinal (GI) tract and can cause a range of diseases like antibiotic-associated diarrhea (AAD), pseudomembrane colitis, and toxic megacolon.
-This pathogen produces toxins A and B, which causes a spectrum of disease, but Human C. diff-associated diarrhea (CDAD) is responsible for 1/4th of all AAD causes, with approximately 3 million causes per year.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306399/

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Name of Disease: C. difficile infection (CDI)

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Name of Disease: C. difficile infection (CDI)

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CDI is an inflammatory condition of the large intestine, and it is characterized by diarrhea and the appearance of plaques and neutrophil accumulation in the lumen of the intestinal lining. The diseases caused by the pathogen include, but are not limited to: toxic megacolon, colonic perforation, and death.

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Pseudomembrane colitis viewed by a scope operation. (colonoscopy)

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A normal, human colon compared to toxic megacolon.

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Microscopic views of a colon with C. diff over 24-36 hours

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Symptoms may develop within a few days after you begin taking antibiotics. These symptoms include:
-Watery diarrhea
-Blood in stool
-Persistent abdominal pain (stomach tenderness)
-Swollen, distended abdomen
-Nausea
-Loss of appetite
-Fever
-Rapid heart rate
Diarrhea and fever are the most common symptoms of C. diff infection. If you have been taking antibiotics recently and have these symptoms, you should see a healthcare professional immediately.

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There are various risk factors for C. diff, but C. diff can ultimately affect anyone. Yearly, around 14,000 people on average in the United States alone are reported to have died from C. diff. It is estimated to cause almost half a million infections in the US each year. About 1 in 6 patients who get C. diff will get it again in 2-8 weeks.

1. Most cases of C. diff occur when you have been taking antibiotics or not long after you have finished a round of antibiotics. Nosocomial C. difficile infection is often contracted when patients are treated with antibiotics. This causes a disturbance in normal gut microflora.

2. Being 65 or older also poses a risk for C. diff. 1 in 11 people over the age of 65 are diagnosed with a healthcare-associated C. diff infection within 1 month.

3. A recent stay at a hospital or residing at a nursing home increases the risk of catching C. diff. C.diff is more common in healthcare settings like hospitals and nursing homes because many people who are colonized with C. diff are staying or being treated in these facilities. Colonization just refers to an individual carrying C. diff.

4. Someone with a weakened immune system or someone who has HIV/AIDS, cancer, or just recently had an organ transplant, are more likely to contract C. diff.
5. Someone with a previous infection of C. diff or known exposure to the germs are more at risk of having C. diff.

https://www.cdc.gov/cdiff/what-is.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306399/

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The doctor will review your signs and symptoms and order a lab test. This will be through the order off of a stool (poop) sample. If it is positive for C. diff, you will take a specific antibiotic for 10 days, like vancomycin, fidaxomicin (Dificid), or metronidazole (Flagyl).

If you were taking an antibiotic for some type of problem, you need to discontinue or stop taking the inciting antibiotic that is causing the weakness in your gut. You also need to make sure you are hydrating yourself with water and electrolytes.

Metronidazole and vancomycin, taken orally, are often clinically used for the treatment of C. difficile infection, but concern about antibiotic resistance is motivating the search for novel non-antibiotic treatments/therapeutics. Fecal transplant and probiotics are also used to replace gut microflora. Also, photodynamic therapy is an option being discussed. Surgery is only used in 1% of patients.

For those with repeat infections, fecal microbiota transplants have shown promising results. It is important to tell your physician if you had C. diff during future visits, as this important information will help them make the best decisions when prescribing antibiotics in the future.

https://www.cdc.gov/cdiff/after.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4306399/

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1. Reduce transmission of C. diff by washing hands with soap and water effectively & as much as possible. C. diff is contagious, so you need to wash your hands every time you use bathroom and always before eating. If you know someone who has C. diff and share a bathroom with them, ask that person to use a separate bathroom if they have diarrhea, or ask them to disinfect the bathroom efficiently after relieving oneself.

2. Avoid unnecessary antibiotic use. Physicians can limit or avoid prescribing antibiotics, unless it is absolutely necessary. Overuse of antibiotics is the most important risk for getting C. diff. Tell your healthcare professional if you have had a C. diff infection before.

3. The antibiotic vancomycin can reduce the risk of C. diff recurrence in high-risk patients.

4. You can educate about yourself on probiotics. Research shows that probiotics inhibit the proliferation and virulence of C. diff by ensuring a healthy gut microbiome. Yogurt is a popular probiotic food and can help combat C. diff. It can help reduce or eliminate watery diarrhea by putting good bacteria back into the GI tract.

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When spores are ingested, they become activated.

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When these germs are on the outside of the body, they become spores. It is an inactive form of the germ with a protective coating that allows them to live for months or sometimes years on surfaces. They become active again when they are swallowed and reach the intestines.

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How do antibiotics affect your microbiome?

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How do antibiotics affect your microbiome?

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What is the microbiome? Your microbiome is the good and bad germs that live in or on your body, like in your stomach, intestines, mouth, urinary tract, and so on. Some of those germs can cause illness, but others are important to your health. A healthy microbiome can protect you from infections like C. diff, but antibiotics disrupt your microbiome. The antibiotics wipe out both the good and bad bacteria for as long as several months, so if you come in contact with C. diff germs during this time, you can get sick.

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Antibiotics can save lives, but anytime they are used, they cause side effects and contribute to antibiotic resistance. We see in the US doctors' offices and emergency departments that approximately 28% of antibiotic courses prescribed each year are UNNECCESSARY.

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Interesting C. diff facts (varies by year, but interesting)

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-November is C. diff Awareness Month according to the C. diff Foundation.
-You are 7 to 10 times more likely to get C. diff infection when taking antibiotics and during the month after. That is because antibiotics that fight bacterial infections by killing bad germs can also get rid of the good germs that protect the body against harmful infections, like C. diff.
-C. diff germs are so small that relative to our size that if we were the size of the state of California, a germ would be the size of a baseball home plate.

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Brain map designed by a medical student to understand C. diff

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In conclusion, we can now see how C. diff manifests, what problems it can cause, who is at risk, how it is acquired, and what we can do to prevent and treat this problem. I work in a hospital/retail pharmacy, and I see lots of patients come and pick these antibiotics up. We also give these antibiotics to a lot of our nursing home/hospice patients.

My boyfriend also has fallen victim to C. diff, and it took him almost half-a-year to treat it and stop feeling side effects. This happened to him due to an overuse of antibiotics. He was prescribed a round of clindamycin for a dentist operation, and he was then prescribed another round of clindamycin for food poisoning in a short amount of time. This killed the bacteria in his gut, and he contracted C. diff. He was then prescribed metronidazole and then vancomycin to try to combat the C. diff. I have never seen doctors prescribe that many different antibiotics to a patient in a short amount of time, and part of that may have been on him going to different doctors every time and not communicating with them of his past doctor visits and diagnoses.

We all need to be aware of this pathogen and the damage it can cause.

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My boyfriend now sees this drug in his nightmares. Because of clindamycin, he contracted C. diff.