Clostridium difficile infection (CDI), also known as C. diff, is among the most common hospital-acquired infections and a frequent cause of death in older hospitalized adults, according to Keystone Infectious Disease’s Medical Director Dr. Raghavendra Tirupathi and medical students Arpitha Sirichandana Baggu, Vaishnavi Vallurupalli, Sai Koushik and Ajay Sriram Antony Raj.
What is C. diff?
C. diff is bacteria that live in the intestines. Normally harmless, it can overgrow when gut bacteria are disrupted, leading to colon inflammation and severe diarrhea.
Causes and Risk Factors
- Antibiotic use is the leading cause, as it can kill beneficial gut bacteria.
- Hospital and long-term care facility stays increase risk due to surface contamination and exposure.
- Risk is higher with longer hospital stays, multiple antibiotics, or weakened immune systems.
- Adults over 65, those with multiple health conditions, Crohn’s disease, ulcerative colitis, or who use stomach-acid reducing drugs face greater susceptibility.
- A prior C. diff infection also increases risk.
Contagion
C. diff spreads easily in healthcare settings. Spores can linger on bed rails, doorknobs, toilets, medical equipment, clothing, or hands. Symptomatic patients are most likely to spread it. Proper handwashing and cleaning surfaces help reduce transmission.
Symptoms
- Early: Watery diarrhea (at least three times daily), abdominal cramps.
- Severe: Diarrhea up to 15 times a day, blood in stool, stomach pain, bloating, nausea, vomiting, loss of appetite, fever, or rapid heart rate.
- C. diff can sometimes exist without diarrhea.
Diagnosis
Diagnosis is usually through stool testing for bacteria or toxins. Testing is only recommended if symptoms are present.
Prevention
- Take antibiotics only as prescribed and finish the course.
- Wash hands with soap and water for at least 20 seconds.
- Disinfect frequently touched surfaces.
- Maintain good hygiene in hospitals and nursing homes.
- Support gut health through nutritious foods.
Treatment
- Asymptomatic carriers usually do not need treatment.
- Symptomatic cases are treated with antibiotics such as fidaxomicin or vancomycin, or metronidazole in some cases.
- If caused by another antibiotic, doctors may stop or change it.
- Severe cases may require stronger treatment, a combination of medications, or rarely, surgery.
- Recurrent cases may be treated with a different antibiotic, longer course, fecal microbiota transplant, or medications such as bezlotoxumab.
Healthcare Settings
Patients in hospitals or long-term care are at higher risk due to close quarters and frequent antibiotic use. Preventive steps include strict handwashing, limiting contact with shared items, asking about antibiotic necessity, and staying in a private room if possible.
This information is for general awareness and should not replace professional medical diagnosis, treatment, or care.
Photo credits to Keystone Health
