Clostridium difficile (klos-TRID-e-um dif-uh-SEEL), often referred to as C. difficile or C. diff, is a bacterium that can cause symptoms starting from diarrhea to life-threatening inflammation of the colon.
Illness from C. difficile most often affects older adults in hospitals or in long-term care facilities and typically happens after use of antibiotic medications. However, studies indicates increasing rates of C. difficile infection among people traditionally not considered high risk, such as younger and healthy individuals without a history of antibiotic use or exposure to health care facilities.
Each year in the United States, about a half million people get sick from C. difficile, and in recent times, C. difficile infections have become more frequent, severe and hard to treat.
Some people carry the bacterium C. difficile in their intestines but do not become sick, though they may still spread the infection. Signs and symptoms usually develop within five to 10 days after starting a course of antibiotics, but may happen as soon as the first day or up to two months later.
Mild to moderate infection
The most regular symptoms of mild to moderate C. difficile infection are:
- Watery diarrhea three or more times a day for two or more days
- Mild abdominal cramping and tenderness
In severe situations, people tend to become dehydrated and may require hospitalization. C. difficile causes the colon to get inflamed (colitis) and sometimes may form patches of raw tissue that can either bleed or produce pus (pseudomembranous colitis). Signs and symptoms of severe infection include:
- Watery diarrhea 10 to 15 times a day
- Abdominal cramping and pain, that may be severe
- Rapid heart rate
- Blood or pus found in the stool
- Loss of appetite
- Weight loss
- Swollen abdomen
- Kidney failure
- Increased white blood cell count
Colon and rectum
- difficile bacteria are seen throughout the environment — in soil, air, water, human and animal feces, and food products, such as processed meats. A small number of healthy people naturally carry the bacteria in their large intestine and don’t have ill effects from the infection.
- difficile infection is most commonly linked with health care and recent antibiotic use, happening in hospitals and other health care facilities where a much higher percentage of people carry the bacteria. However, studies show increasing rates of community-associated C. difficile infection, which happen among populations traditionally not considered high risk, such as children and people without a history of antibiotic use or recent hospitalization.
Spores from C. difficile bacteria are also passed in feces and spread to food, surfaces and objects when people who are infected do not wash their hands thoroughly. These spores can persist in a room for weeks or months. If you touch a surface contaminated with C. difficile spores, you may then unknowingly swallow the bacteria.
Your intestines has about 100 trillion bacterial cells and up to 2,000 different kinds of bacteria, many of which assist protect your body from infection. When you take an antibiotic to treat an infection, these drugs actually try destroy some of the normal, helpful bacteria in addition to the bacteria creating the infection. Without enough healthy bacteria to keep it in check, C. difficile can quickly grow out of control. The antibiotics that most often result to C. difficile infections include fluoroquinolones, cephalosporins, penicillins and clindamycin.
Once established, C. difficile can create toxins that attack the lining of the intestine. The toxins destroy cells and produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon and cause watery diarrhea.
Emergence of a new strain
An aggressive strain of C. difficile has emerged that creates far more toxins than other strains do. The new strain may be more resistant to certain medications and has shown up in people who haven’t been in the hospital or taken antibiotics. This strain of C. difficile has created several outbreaks of illness since 2000.
Although people — including children — with not known risk factors have gotten sick from C. difficile, certain factors increase your risk.
Taking antibiotics or other medications
Medication-linked risk factors include:
- Currently taking or having recently taken antibiotics
- Taking broad-spectrum antibiotics that target a wide range of bacteria
- Using multiple antibiotics
- Taking antibiotics for a long time
- Taking medications to reduce stomach acid, inclusive of proton pump inhibitors
Staying in a health care facility
The majority of C. difficile cases happen in, or after exposure to, health care settings — including hospitals, nursing homes and long-term care facilities — where germs spread easily, antibiotic use is common and people are especially vulnerable to infection. In hospitals and nursing homes, C. difficile spreads mainly on hands from person to person, but also on cart handles, bedrails, bedside tables, toilets, sinks, stethoscopes, thermometers — even telephones and remote controls.
Having a serious illness or medical procedure
If you have a serious illness, such as inflammatory bowel disease or colorectal cancer, or a weakened immune system as a result of a medical condition or treatment (such as chemotherapy), you are more susceptible to a C. difficile infection. Your risk of C. difficile infection is also greater if you’ve had abdominal surgery or a gastrointestinal procedure.
Older age is also a risk factor for C. difficile infection. In one research, the risk of becoming infected with C. difficile was 10 times greater for people age 65 and older compared with younger people.
After having a previous C. difficile infection, your chances of having a recurring infection can be up to 20 percent, and the risk increases further with every subsequent infection.
Complications of C. difficile infections are inclusive of:
- Severe diarrhea can result to a significant loss of fluids and electrolytes. This makes it hard for your body to function normally and can cause blood pressure to drop to dangerously low levels.
- Kidney failure.In some cases, dehydration can happen so quickly that kidney function rapidly deteriorates (kidney failure).
- Toxic megacolon.In this rare case, your colon is unable to expel gas and stool, causing it to become greatly distended (megacolon). Left untreated, your colon may rupture, making bacteria from the colon to enter your abdominal cavity. An enlarged or ruptured colon needs emergency surgery and may be fatal.
- A hole in your large intestine (bowel perforation).This is rare and results from extensive damage to the lining of your large intestine or after toxic megacolon. A perforated bowel can spill bacteria from the intestine into your abdominal cavity, leading to a life-threatening infection (peritonitis).
- Even mild to moderate C. difficile infections can quickly progress to a fatal disease if not treated promptly.
To help stop the spread of C. difficile, hospitals and other health care facilities follow strict infection-control guidelines. If you have a friend or family member in a hospital or nursing home, don’t be afraid to remind caregivers to follow the recommended precautions.
Preventive measures are inclusive of:
- Hand-washing.Health care workers should practice good hand hygiene before and after treating each person in their care. In the situation of a C. difficile outbreak, using soap and warm water is a better choice for hand hygiene, because alcohol-based hand sanitizers do not effectively destroy C. difficile spores. Visitors also should wash their hands with soap and warm water before and after leaving the room or using the bathroom.
- Contact precautions.People who are hospitalized with C. difficile have a private room or share a room with someone who has the same illness. Hospital staff and visitors wear disposable gloves and isolation gowns while in the room.
- Thorough cleaning.In any situation, all surfaces should be carefully disinfected with a product that contains chlorine bleach. C. difficile spores can survive routine cleaning products that don’t contain bleach.
- Avoid unnecessary use of antibiotics.Antibiotics are sometimes prescribed for viral illnesses that aren’t assisted by these drugs. Take a wait-and-see attitude with simple ailments. If you do need an antibiotic, ask your doctor to prescribe one that has a narrow range and that you take for the shortest time possible.