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Clostridium difficile

Conditions

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Clostridium difficile or C. diff bacteria can be very harmful. They affect the intestinal tract and can cause symptoms ranging from mild diarrhea to severe inflammation of the colon (large intestine).

C. diff infection is most common during or days to weeks after treatment with antibiotics. Anyone can become infected. The risk is greatly increased for people in hospitals and for people living in nursing homes or long-term care facilities. However, other and chronic conditions (tube feeding, chronic intestinal disorders [such as inflammatory bowel disease or IBD], oncological conditions) can also predispose someone (including children) to developing C. diff infection. This is because medical facility exposure and antibiotic use is common under such conditions.

Patients can be seen by Texas Children's experts in Inflammatory Bowel Disease Center and Microbiome Center.

Causes & Risk Factors

The stomach and intestines have hundreds of kinds of bacteria. Many of these bacteria actually help keep harmful bacteria like C. diff from causing problems. Small amounts of C. diff are normal and do not cause problems.

When a person takes an antibiotic, the normal balance of good and bad bacteria may be affected. There may be too little good bacteria and too much harmful bacteria like C. diff.

In hospitals and nursing homes, C. diff (that produces very resistant spores) may be spread from an infected patient to other patients. This may occur when staff or visitors touch infected patients or objects, such as bed rails, stethoscopes, or bedpans and then touch other patients or surfaces.

Symptoms & Types

About half of the people with C. diff infection have no symptoms. Yet they can still pass the infection to others. Others do have symptoms. These include:

  • Watery diarrhea, which may contain mucus
  • Pain, and cramping
  • Fever

Some who are infected develop serious problems. Symptoms include:

  • Abdominal pain
  • Abdominal swelling
  • Nausea, and vomiting
  • Little or no diarrhea

Diagnosis & Tests

To confirm the infection, a sample of stool is tested for the bacteria or the toxins made by the bacteria.

Treatment & Care

The first step is to stop taking antibiotics. A different medication may be prescribed. In certain cases, an antibiotic directed at the C diff infection may be given.

  • The antibiotics usually prescribed against C. diff infection are metronidazole (first line agent) and vancomycin (second line agent). Recurrence of the infection may occur after a course of these antibiotics, however. There are newer antibiotics, such as fidaxomicin, which may provide benefit in such situations. In the meantime, over the past years, fecal microbiota transplantation (transfer of stool from a healthy person into the intestines of a patient with C. diff infection) has been recognized to deliver outstanding cure rates (90%) for patients with antibiotic refractory infection.
  • Fluids are often given intravenously (IV) or through a vein. This helps replace fluids lost through diarrhea.
  • Surgery may be needed if treatment fails to cure severe symptoms, but this option is reserved to life threatening situations, which are extremely rare in children

To lessen symptoms:

  • Drink plenty of fluids to replace water lost through diarrhea. Talk with your health care provider or nurse about which fluids are best.
  • Follow your health care provider's instructions for when and what to eat.
  • Unless your health care provider tells you to do so, do not take medications for diarrhea.
  • Tell your health care provider if symptoms return. Even after treatment, C. difficile may come back.

Prevention

Patients can do the following to help prevent C. diff:

  • Take antibiotics only when you really need them. Antibiotics don't help treat illnesses caused by viruses. This includes colds and the flu. Don't ask for antibiotics from your health care provider if she says they won't work.
  • When you are given antibiotics, take them as directed.  Don't increase or decrease the dosage. Do not take them for shorter or longer than your provider tells you to, even if you feel better.
  • Wash your hands carefully.  Do this after using the bathroom and before eating. Use plenty of soap and warm water. Alcohol-based hand cleaners may not work against C. diff germs.

Everyone can help prevent C. diff with the following:

In a hospital or care facility:

  • Wash your hands well before and after visiting someone who has C. diff infection. Use soap and water. Alcohol-based hand cleaners may not work against C. diff.
  • If the staff asks you to, wear gloves. Take any other steps you are asked to follow to help prevent infection.

At home:

  • Wear gloves when caring for a family member with C. diff infection. Throw the gloves away after each use. Then wash your hands well.
  • Wash the patient's clothes, bed linen and towels separately. Use hot water. Use both detergent and liquid bleach.
  • Disinfect surfaces in the patient's room. This includes the phone, light switches, and remote controls.

Practice good handwashing:

  • Use warm water and plenty of soap. Rub your hands together well.
  • Clean the whole hand. Wash under nails, between fingers, and up the wrists.
  • Wash for at least 15 seconds to 20 seconds.
  • Rinse.  Let the water run down your fingers, not up your wrists.
  • Dry your hands well.  Then use a paper towel to turn off the faucet and open the door.

More Information

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3970838/

http://www.asmbranches.org/brcano/meetings/2014SprPpts/4.3Hollister_NCASM_2014.pdf

http://paperity.org/p/36656694/pediatric-fecal-microbiota-transplantation

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829459/