Clostridium Difficile : Infection Symptoms, Prevention and Treatment
Author: Thomas C. Weiss : Contact: https://www.disabled-world.com
Published: 2014-09-12 : (Rev. 2020-03-21)
Synopsis and Key Points:
Information regarding Clostridium difficile, also known as C. difficile or simply C. diff, a bacteria with symptoms ranging from diarrhea to life-threatening inflammation of the colon.
Some people carry the C. diff bacterium in their intestines, yet never become ill, although they may still spread the infection.
C. difficile bacteria are found throughout the environment in air, soil, water, animal and human feces, as well as food products to include processed meats.
Illness from C. diff most commonly affects older adults in hospitals or long-term care facilities and usually occurs after use of antibiotics. Studies; however, have shown increasing rates of C. diff infection among people traditionally not considered to be high risk such as healthy younger people without a history of antibiotic use or exposure to health care facilities. Every year, more than a half-million people become ill from C. diff and in more recent years, C. diff infections have become more frequent, severe and hard to treat.
Symptoms of C. Difficile Infection
Some people carry the C. diff bacterium in their intestines, yet never become ill, although they may still spread the infection. C. diff illness usually develops during, or within a few months after, a course of antibiotics. What follows are descriptions of the symptoms associated with mild to moderate and severe C. diff infections.
- Mild to Moderate C. Diff Infection Symptoms: The most common symptoms of a mild to moderate C. diff infection include watery diarrhea 3 or more times a day for 2 or more days, as well as mild abdominal tenderness and cramping.
- Severe C. Diff Infection Symptoms: In severe C. diff infections, people often become dehydrated and might require hospitalization. C. Diff causes a person's colon to become inflamed and sometimes might form patches of raw tissue that may bleed or produce pus.
The signs and symptoms of a severe C. diff infection can include the following:
- Weight loss
- Appetite loss
- Kidney failure
- Swollen abdomen
- Pus or blood in the stool
- Increased white blood cell count
- Watery diarrhea 10-15 times daily
- Abdominal cramping and pain at times severe
Some people experience loose stools during, or shortly after, antibiotic therapy - potentially due to C. diff infection. Visit your doctor if you have 3 or more watery stools a day and symptoms lasting more than 2 days, or if you have a new fever, severe abdominal cramping or pain, or blood in your stool.
C. difficile bacteria are found throughout the environment in air, soil, water, animal and human feces, as well as food products to include processed meats. A small number of healthy people naturally carry the bacteria in their large intestine and do not have ill effects from the infection. C. diff infection is commonly associated with health care, occurring in hospitals and other health care facilities where a larger percentage of people carry the bacteria. Studies; however, show increasing rates of community-associated C. diff infection, which happens among populations traditionally not considered to be high risk, such as children and people without a history of antibiotic use, or a recent hospitalization.
C. diff bacteria are passed in feces and spread to surfaces, food and objects when people who are infected do not wash their hands appropriately. The bacteria produce spores that may persist in a room for weeks or even months. If you touch a surface contaminated with C. difficile you might then unknowingly swallow the bacteria.
A person's intestines contain millions of bacteria, a number of which help protect their body from infection. Yet when you take an antibiotic to treat an infection, the medication may destroy some of the helpful bacteria as well as the bacteria causing the illness. Without enough healthy bacteria, C. diff can rapidly grow out of control. The antibiotics that most often lead to C. diff infections include cephalosporins, flouroquinolones, and penicillins. Once established, C. diff can produce toxins that attack the lining of the intestine. The toxins destroy cells and produce patches of inflammatory cells and decaying cellular debris inside the colon and cause watery diarrhea. It is important to be aware that an aggressive strain of C. difficile has emerged that produces far more toxins than other strains do. The new strain might be more resistant to certain medications and has appeared in people who have not been in hospitals or taken antibiotics. The strain of C. diff has caused a number of outbreaks of illness since the year 2000.
While people with no known risk factors, to include children, have become ill from C. diff infections, certain factors increase a person's risk. What follows is a breakdown of the risks for C. diff infection:
- Older Age: Age is also a risk factor for C. diff infection. One study showed the risk of becoming infected with C. diff was 10 times greater for those over the age of 65.
- Prior Infection: After a previous C. diff infection, a person's chances of experiencing a recurring infection may be up to 20%. The risk increases more with each subsequent infection.
- Taking Antibiotics/Other Medications: If a person is currently taking or has recently taken antibiotics, has taken a broad-spectrum antibiotic, used multiple antibiotics, taken antibiotics for an extended period of time, or taken medications to reduce stomach acid - they are at increased risk of a C. diff infection.
- Experiencing a Serious Illness or Medical Procedure: If a person experiences a serious illness such as colorectal cancer or inflammatory bowel disease, or a weakened immune system as a result of a medical treatment or condition, they are more susceptible to a C. diff infection. Their risk of C. diff infection is also greater if they have had abdominal surgery or a gastrointestinal procedure.
- Staying in a Health Care Facility: Most C. diff infections happen in, or after exposure to, health care facilities. These facilities include hospitals, long-term care facilities and nursing homes where germs spread easily, antibiotic use is common, and people are particularly vulnerable to infection.
In hospitals and nursing homes, C. diff spreads mainly on hands from person to person, yet also on:
- Cart handles
- Bedside tables
- Remote controls
A C. diff infection can present a number of complications. The complications of C. diff infections may include the following:
- Death: Even mild to moderate C. diff infections may quickly progress to a fatal disease if not treated quickly.
- Kidney Failure: In some instances, dehydration can happen so fast that kidney function rapidly deteriorates and the person's kidneys fail.
- Dehydration: Severe diarrhea may lead to a significant loss of electrolytes and fluids. The loss makes it hard for a person's body to function as usual and might cause their blood pressure to drop to dangerously low levels.
- Bowel Perforation: Bowel perforation is rare and results from extensive damage to the lining of a person's large intestine. A perforated bowel may spill bacteria from the person's intestine into their abdominal cavity and lead to a life-threatening infection.
- Toxic Megacolon: In this condition, a person's colon becomes unable to expel gas and stool, causing it to become greatly distended. If untreated, the person's colon may rupture, causing bacteria from their colon to enter their abdominal cavity. A ruptured colon requires emergency surgery and might be fatal.
C. Diff Tests and Diagnosis
A doctor often times suspects C. diff in anyone with diarrhea who has recently taken antibiotics, or when diarrhea develops a few days after hospitalization. When this happens, a person is likely to have one or more of the tests below.
Toxins produced by C. difficile bacteria can usually be detected in a sample of a person's stool. Some main types of lab tests exist to include:
- Enzyme Immunoassay: The majority of labs use the enzyme immunoassay (EIA) test which is quicker than other tests, yet is not sensitive enough to detect many infections and has a higher rate of false, 'normal,' tests.
- Polymerase Chain Reaction: The test is a sensitive molecular test that can quickly detect C. difficile toxin B gene in a stool sample and is very accurate. The test is now being adapted by several labs and becoming more widely available.
- Colon Examination: Rarely, to help confirm a diagnosis of C. diff infection, a doctor might examine the inside of a person's colon. The test involves inserting a flexible tube with a small camera on one end into the person's colon to look for areas of inflammation and pseudomembranes.
- Imaging Tests: If a doctor is concerned about potential complications of C. diff they might order an abdominal X-ray, or a computerized tomography (CT) scan. The scan can detect the presence of complications such as expanding of the bowel, thickening of the colon wall, or a hole in the lining of a person's colon.
- Cell Cytotoxicity Assay: A cytotoxicity test looks for the effects of the C. difficile toxin on human cells grown in a culture. The test is sensitive but less widely available and is more cumbersome to perform. It requires more than 24-48 hours for test results. Some hospitals use both the EIA test and cell cytotoxicity assay to ensure results that are accurate.
The first step in treating a C. diff infection is to stop taking the antibiotic that triggered it if possible. Depending upon the severity of the infection treatment may include the following:
- Antibiotics: Ironically, the standard treatment for a C. diff infection is - another antibiotic. The antibiotics keep C. diff from growing, which treats diarrhea and other complications. For mild to moderate infection, doctors usually prescribe oral metronidazole. Metronidazole is not FDA approved for C. diff infections, yet has been shown to be effective in mild to moderate ones. Side-effects of metronidazole include a bitter taste and nausea. For more severe and recurrent cases, oral vancomycin might be prescribed.
- Surgery: For people who experience severe pain, inflammation of the lining of their abdominal wall, or organ failure - surgery to remove the diseased portion of their colon might be the only option.
Treating Recurrent C. Diff Infections
- Up to 20% of people with a C. diff infection get sick again, either because the initial infection did not go away or because they have become reinfected with a different strain of the bacteria. After one or more recurrences, rates of further recurrence increase by up to 65%. Treatment for recurrent C. diff infections may include the following:
- Probiotics: Probiotics are organisms such as yeast and bacteria which help to restore a healthy balance to a person's intestinal tract. A yeast called, 'Saccharomyces boulardii,' along with antibiotics may help to prevent further recurrent C. diff infections.
- Antibiotics: Antibiotic therapy for C. diff infection recurrence may involve one or more courses of an antibiotic, usually vancomycin, a gradually tapered dose of medication or an antibiotic administered once every few days - a method referred to as a, 'pulse regimen.' For a first recurrence, the effectiveness of antibiotic therapy is approximately 60% and declines with each subsequent recurrence.
- Fecal Microbiota Transplant (FMT): Also referred to as a, 'stool transplant,' FMT is emerging as an alternative strategy for treatment of recurrent C. diff infections. While it has not yet been approved by the FDA, clinical studies of FMT are underway. FMT restores healthy intestinal bacteria by placing a donor's stool in the infected person's colon using a colonoscope or nasogastric tube. Donor stools are screened for viruses, parasites, bacteria and certain antibodies prior to use.
- To help prevent the spread of C. difficile, hospitals and other health care facilities follow strict infection control guidelines. If you have a family member or friend in a hospital or nursing home, do not be afraid to remind caregivers to follow the recommended precautions. Preventative measures include the following:
- Clean Thoroughly: In any setting, all surfaces should be carefully disinfected with a product that contains chlorine bleach. C. diff spores can survive routine cleaning products that do not contain bleach.
- Contact Precautions: People who are hospitalized with C. diff have a private room or share a room with a person who has the same illness. Hospital staff and visitors wear disposable gloves and gowns while they are in the person's room.
- Avoid Unnecessary Use of Antibiotics: Antibiotics are at times prescribed for viral illnesses that are not helped by them. If you do require an antibiotic, ask your doctor to prescribe one that has a narrow range and that you take for the shortest time possible.
- Hand Washing: Health care workers should practice good hand hygiene both before and after treating each person in their care. In the event of a C. diff outbreak, using warm water and soap is a better choice for hand hygiene because alcohol-based hand sanitizers do not effectively destroy C. diff spores. Visitors should also wash their hands with warm water and soap before and after leaving the room or using the bathroom.
- Infections with the intestinal superbug C. difficile nearly doubled from 2001 to 2010 in U.S. hospitals without noticeable improvement in patient mortality rates or hospital lengths of stay, according to a study of 2.2 million C. difficile infection (CDI) cases.
- In a study from The University of Texas College of Pharmacy, researchers analyzed 10 years of data from the U.S. National Hospital Discharge Surveys (NHDS). From 2001 to 2010, rates of CDI among hospitalized adults rose from 4.5 to 8.2 CDI discharges per 1,000 total adult hospital discharges.
- Several factors may have contributed to the rise in CDI incidence in recent years, and antibiotic exposure remains the most important risk factor for CDI. According to APIC 2014 President Jennie Mayfield, BSN, MPH, CIC, it's been estimated that up to half of antibiotic use in humans is unnecessary.
- According to the CDC, C. difficile is the most common bacteria responsible for causing healthcare-associated infections in U.S. hospitals and is linked to 14,000 deaths each year. Reducing the use of high-risk, broad-spectrum antibiotics by 30 percent could lower CDI by 26 percent, estimates the CDC.
- According to The University of Texas College of Pharmacy study, most CDI patients were female (59 percent), white (86 percent), and more than 65 years of age (70 percent).
- Of the 2.2 million adult CDI discharges, 33 percent had a principal diagnosis of CDI; 67 percent were classified as secondary CDI, meaning that CDI was not the primary reason they were hospitalized. Approximately 7.1 percent, or 154,184 patients, died during the study period.
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