By Gastroenterology Associates of S.W. Florida, P.A. –
Clostridium difficile (C. diff) is a bacterial infection that can lead to fever, abdominal pain and cramping, severe diarrhea, and, at its worst, toxic megacolon, bowel perforation and possibly death. The CDC estimates that diarrhea associated with C. diff is linked to 14,000 deaths per year. C. diff is a healthcare associated illness. Those most at risk are persons older than 64 years, persons with lengthy or multiple hospitalizations, and exposure to antibiotics.
Antibiotics are the main modifiable risk factor associated with C. diff infection. The large intestine, or colon, is naturally colonized with numerous bacteria that are beneficial to our health. When antibiotics are taken for infections elsewhere in the body, these “good bacteria” are killed right along with the bad. Once the “good bacteria” or, flora are killed, C. diff has the opportunity to attach to the wall of the colon. The bacteria secrete toxins that cause inflammation of the colon leading to the abdominal pain, fever and diarrhea.
The illness is spread by coming in contact with someone already infected with C. diff, by healthcare workers, or by coming into contact with contaminated surfaces. A feature of this bacterium that is different from others is its ability to produce spores. The spores are very resistant and can survive for months or years on surfaces, much like a seed waiting to germinate. Typical alcohol based hand sanitizers cannot kill these spores. Washing ones hands very thoroughly with soap and water is probably the best way to protect one’s self from acquiring this bacterium.
C. diff is treated with antibiotics that can target and kill the bacteria and the spores that they form. Initially, treatment is with metronidazole for two weeks. In the event of recurrence different antibiotics are used for varying lengths of time. Some cases that are very resistant to antibiotic treatment may be treated with a fecal transplant. This basically means that the stool from a healthy donor is delivered to the colon of the infected person. This can be done a couple different ways. After screening the donor for infection, a tube can be inserted through the nose and into the small intestine where the sample is delivered. Alternatively, it can be done by spraying the walls of colon with the donor’s stool during a colonoscopy. The hope is that the flora or “good bacteria” from the donor’s stool will flourish in the infected person and therefore, block available attachment sites for C. diff.
If you, the reader, have C. diff, or are caring for someone with C. diff, it is crucial to remain hydrated. You can go fairly long periods of time without eating, but you cannot survive for very long without fluids. If diarrhea is severe and signs of dehydration develop including dizziness, palpitations and low volumes of dark urine, it is time to seek medical attention and head to the hospital for IV fluid support. If it can be safely managed at home, it is important to clean areas such as the bathroom and surfaces that are touched frequently with a solution of one part bleach to ten parts water. Hands should be washed thoroughly after each trip to the bathroom and before eating or handling food. A quick rinse under the water is not sufficient! Work up a good lather and wash hands for the amount of time it takes to sing the “Happy Birthday” song. Be careful to clean under finger nails as well.
If you have come in contact with someone that has C. diff and are concerned, watch for signs of illness. If you have not developed diarrhea, there is no need to worry or even to be tested yourself. The takeaway messages I leave you with is that C. diff is a healthcare associated illness that occurs mostly in elderly people, those who have been hospitalized, or who have used antibiotics in the previous few months. It can be very severe and debilitating, but can be treated effectively by your physician. With C. diff as with any other illness causing diarrhea it is important to drink plenty of fluids to keep your body hydrated. Thorough, careful and frequent hand washing is the key to prevention.