Clostridiumdifficile infection (also known as C. diff or CDI) is one of the most common hospital-acquired infections and is a frequent cause of death among hospitalized older adults. Keystone Infectious Disease’s Medical Director, Dr. Raghavendra Tirupathi, and medical students studying under him, Arpitha Sirichandana Baggu, Vaishnavi Vallurupalli, Sai Koushik and Ajay Sriram Antony Raj, explain how to keep yourself safe in today’s Take Care article.
What is C. diff?
C.diff is a type of bacteria that lives in the intestines. Usually it doesn’t cause problems, but when the balance of good bacteria in your gut is disrupted, it can grow out of control. This overgrowth can lead to inflammation of the colon and severe diarrhea.
What are the causes & risk factors?
Antibiotic use is one of the most frequent causes. While highly effective at treating infections, antibiotics can also destroy the good bacteria in your digestive tract. When that occurs, C. diff may multiply and release toxins that cause illness.
Because C. diff can live on surfaces and spread easily, people who spend time in hospitals or long-term care facilities are more vulnerable. Additionally, the longer you stay in the hospital or care facility, the longer you take antibiotics or if you have taken multiple antibiotics, the higher the risk. Due to weakened immune systems and more frequent medical visits, older adults, especially those over 65, are also more susceptible to infection.
Other factors that increase risk include having multiple health conditions, a weakened immune system, a digestive disorder like Crohn’s disease or ulcerative colitis, taking drugs that lower stomach acid (like proton pump inhibitors) and previous C. diff infection.
Is it contagious?
Yes, C. diff can spread very easily. It is most often spread through contact with surfaces or equipment, especially in healthcare settings. Invisible traces of the bacteria can stick around for a long time, which is why hospitals and nursing homes often take extra care to prevent the spread.
In healthcare settings, spores are often found on things like bed rails, doorknobs, toilets, medical equipment and even on the hands, clothes or stethoscopes of healthcare workers. This makes it easy for the infection to spread, especially between patients who share a room. People who have symptoms are more likely to spread it than those who do not feel sick. Proper hygiene practices like good handwashing and thorough cleaning of possibly contaminated surfaces can greatly reduce the risk of spread.
What are the symptoms?
Early on, C. diff can be mistaken for food poisoning, a stomach virus or a side effect of antibiotic use. The most common and often earliest symptom of CDI is watery diarrhea. In mild cases, this typically happens at least three times a day and may be accompanied by abdominal cramps. As the infection worsens, diarrhea can become more frequent, occurring up to15 times daily. You might also see blood in your stool or experience other symptoms such as stomach pain, bloating/swelling of the abdomen, nausea, vomiting, loss of appetite, fever and rapid heart rate. It’s important to note that C. diff can sometimes be present without diarrhea.
How is the infection diagnosed?
The most common method is by testing your stool for the bacteria/toxins. The CDC recommends testing only if symptoms are present. If C. diff is found and you receive treatment, there is no need to test again after the treatment is completed, as the bacteria can still be present.
Is it possible to prevent C. diff infection?
Yes, C. diff infections can be prevented! Taking simple steps like washing hands with soap and water for at least 20 seconds, regularly disinfecting frequently-touched surfaces, eating healthy foods to keep good bacteria in your gut and paying extra attention to hygiene in hospitals and nursing homes can greatly reduce your chances of infection.
In addition, it’s important to use antibiotics exactly as prescribed, including finishing the full course even if you are feeling better. Never take antibiotics that have not been prescribed for you and avoid unnecessary medications that may disrupt your gut’s microbiome.
How is the infection treated?
Treatment depends on how severe the infection is. People who carry the bacteria but don’t have symptoms usually don’t need treatment. But if symptoms like diarrhea are present, your healthcare provider will likely prescribe an antibiotic such as fidaxomicin or vancomycin, which are taken by mouth for about 10 days. If those aren’t available, metronidazole may be used in some cases. Good hygiene, including thorough handwashing, is important to help prevent the spread of C. diff and protect others.
If you’re on other antibiotics that may have triggered the infection, your doctor may stop or change them. For more serious cases, stronger treatments or a combination of medications might be needed. In rare and severe cases, surgery may be considered. If the infection comes back (which can happen), your doctor might adjust the treatment plan. The change could include different antibiotics, longer treatment or options like fecal microbiota transplant (a procedure to restore healthy gut bacteria). In some cases, a special medicine called bezlotoxumab may be added to help prevent the infection from returning.CDI sometimes comes back after treatment. You’re more likely to have this happen if you’re 65 or older, need to take antibiotics again soon after treatment, use certain stomach acid medications (like proton pump inhibitors), have kidney problems or a severe illness.
If you’ve had C. diff before, it’s important to let your doctor know right away if symptoms return, especially diarrhea, so they can treat it early and help prevent more complications.
What if I’m in a healthcare setting?
If you’re in a hospital or long-term care facility, you may be at higher risk for CDI because of close contact with other patients and frequent use of antibiotics. To reduce your risk, follow strict hand hygiene; wash your hands regularly with soap and water, avoid touching shared items like bed rails or phones without cleaning your hands afterward and remind healthcare workers to do the same before touching you. Ask about your antibiotics, whether they’re necessary and if they could increase your risk. If it’s possible, staying in a private room can reduce risk. This is especially important if you are infected, to prevent spreading it to others.
This article contains general information only and should not be used as a substitute for professional diagnosis, treatment or care by a qualified health care provider.
