What is Clostridium Difficile (C. diff) infection? What are the risk factors and symptoms of C. diff infection? How is C. diff diagnosed?

Understanding Clostridium Difficile (C. diff) Infection

Clostridium Difficile (C. diff) is a bacterium commonly found in the soil, air, and water. It is present in small amounts in the bodies of 1 to 3% of the U.S. population. Under normal circumstances, C. diff doesn’t cause any harm. However, it can become opportunistic and multiply, crowding out the beneficial bacteria in the gut, often during or after a course of antibiotics.

Risk Factors for C. diff Infection

An estimated two-thirds of C. diff infections originate in hospitals, long-term care facilities, or other health care settings. People are seven to 10 times more likely to get C. diff while taking antibiotics and for up to one month after. Other risk factors include immunosuppressive medications, being over age 65, and using proton pump inhibitors (medications that decrease stomach acid).

Symptoms of C. diff Infection

Symptoms of C. diff infection can range from slightly loose stools to more than two dozen episodes of diarrhea a day. Abdominal pain and fever can also occur. In severe cases, C. diff infection can lead to life-threatening dehydration, low blood pressure, toxic megacolon (an acutely distended colon that requires surgery), and colon perforation.

Diagnosis of C. diff Infection

Doctors will suspect C. diff infection when a person develops diarrhea within two months of using an antibiotic. A lab test confirms the diagnosis by looking for one of the toxins produced by C. diff in a stool sample.

Preventing the Spread of C. diff

C. diff bacteria can survive for months and aren’t easily eradicated by all disinfectants. Only cleaners such as bleach can kill the spores. Thoroughly washing your hands with soap and water can remove spores from hands.

Recurrent C. diff Infections

About 20% of patients with a C. diff infection experience recurrent infections. Factors that can contribute to recurrent infections include ongoing antibiotic use, weakened immune systems, and the ability of C. diff to form spores that can survive in the environment.

Treating C. diff Infections

Treatment for C. diff infections typically involves antibiotics that target the C. diff bacteria. In severe cases, surgery may be necessary to remove the infected portion of the colon. Preventing the spread of C. diff and reducing the risk of recurrent infections are also important considerations in managing this healthcare-associated infection.

Why is C. diff infection a concern in healthcare settings?
C. diff infection is a major concern in healthcare settings because it is one of the most common healthcare-associated infections in the United States. The infection can spread easily in hospitals and long-term care facilities, where many patients are taking antibiotics and are susceptible to infection. Healthcare workers who care for multiple patients can also contribute to the transmission of C. diff.

How can I reduce my risk of getting a C. diff infection?
To reduce your risk of getting a C. diff infection, it’s important to practice good hygiene, such as thoroughly washing your hands with soap and water, especially after using the bathroom and before eating. Avoid unnecessary antibiotic use, and if you do take antibiotics, be sure to complete the full course as prescribed. If you’re a patient in a healthcare facility, ask your healthcare providers about infection control measures they are taking to prevent the spread of C. diff.

What should I do if I suspect I have a C. diff infection?
If you develop diarrhea, especially after taking antibiotics, it’s important to see your healthcare provider right away. They can perform a laboratory test to confirm whether you have a C. diff infection and provide appropriate treatment. Early diagnosis and treatment are crucial, as C. diff infections can become severe if left untreated.

How is a C. diff infection treated?
Treatment for a C. diff infection typically involves antibiotics that target the C. diff bacteria, such as metronidazole or vancomycin. In severe cases, surgery may be necessary to remove the infected portion of the colon. Preventing the spread of C. diff and reducing the risk of recurrent infections are also important considerations in managing this healthcare-associated infection.

Can C. diff infections be prevented?
Yes, there are several measures that can help prevent the spread of C. diff infections. Practicing good hand hygiene, using proper disinfection methods, and limiting antibiotic use are all important steps. Healthcare facilities also play a crucial role in implementing infection control measures to prevent the transmission of C. diff among patients.

What are the long-term consequences of a C. diff infection?
In most cases, a C. diff infection can be treated effectively with antibiotics. However, some patients may experience recurrent infections, which can be challenging to manage. Severe cases of C. diff infection can lead to complications such as toxic megacolon, colon perforation, and even death. Prompt diagnosis and appropriate treatment are essential to prevent these serious complications.

How common are C. diff infections in the United States?
C. diff infections are quite common in the United States, with an estimated half a million cases occurring each year. The infection is one of the most common healthcare-associated infections, and it can also occur in the community setting. As antibiotic-resistant strains of C. diff have emerged, the prevalence and severity of these infections have increased in recent years.

Clostridium Difficile (C. Diff) > Fact Sheets > Yale Medicine

Overview

Think of the trillions of bacteria, viruses, and fungi as a community (called your microbiome) that works together to keep your body functioning well. Most of these organisms are beneficial, with specific jobs to do, such as helping your body digest food and distribute nutrients. A healthy person’s microbiome also contains a small number of bacterium that aren’t so friendly.

When your microbiome is in a state of balance, the good guys keep the bad ones under control. If the balance is disrupted—either because the helpful bacteria are eradicated (as can happen when you take antibiotics) or because the harmful community overgrows—your health can suffer. In recent years, one type of bacterium, called Clostridium difficile (C. diff), is presenting particularly difficult challenges, because it causes one of the most common health care-associated infections in the United States. What’s more, about 20% of patients have recurrent infections.

A C. diff infection causes diarrhea, which can range from mild to severe, and in rare cases, can lead to serious complications. The infection most often enters the body after someone touches a surface contaminated with feces from a person infected with C. diff and then touches his or her mouth.

Even if C. diff enters your body, in most cases, it doesn’t make you sick. But recent antibiotic use and a stay in a hospital or long-term care facility can make you more susceptible to becoming infected. There are several reasons why this is so. In such settings, many patients are taking antibiotics, and they are often older (another risk factor) and sicker (yet another—it can do more damage in someone whose immune system is already suppressed and is therefore less able to fight it off). Also, C. diff is resistant to some disinfectants and health care workers tend to many patients, one after the next, so the likelihood of transmission is high as well.  

What is C. diff?

Clostridium difficile (C. diff) is a bacterium commonly found in the soil, air, and water. It is present in small amounts in the bodies of 1 to 3% of the U.S. population. Under normal circumstances, it doesn’t cause any harm. But it is opportunistic, and if given room to grow, it multiplies and crowds out the beneficial bacteria in the gut. This can happen during or after a course of antibiotics, which are meant to kill bacteria that cause infections, but also end up wiping out the helpful bacteria.  

When a C. diff infection takes hold, it releases toxins that inflame the lining of the colon, causing symptoms ranging from slightly loose stools to severe diarrhea, as well as fever and abdominal pain. 

What are risk factors for C. diff?

An estimated two-thirds of C. diff infections originate in hospitals, long-term care facilities, or other health care settings. Often, a C. diff infection develops once the patient is home. And cases acquired solely in the community (not in a hospital or similar setting) have also been on the rise.

People are seven to 10 times more likely to get C. diff while taking antibiotics and for up to one month after, according to the CDC. For some people, an infection may occur several months after completing a course of antibiotics. However, antibiotic use alone does not mean a person who is exposed to the bacteria will necessarily get an infection, or a bad one at that.

Also, C. diff bacteria can survive for months and aren’t easily eradicated by all disinfectants (including alcohol-based hand sanitizers). Only cleaners such as bleach can kill the spores. Thoroughly washing your hands with soap and water can remove spores from hands. 

Other risk factors include the following: 

• Immunosuppressive medications: People who are undergoing chemotherapy and other treatments that suppress the immune system are less able to defend themselves against C. diff.
• People over age 65: Almost half of infections are in people younger than 65, but more than 90 percent of C. diff-related deaths are in people over age 65.
• Use of proton inhibitor pumps: Medications that decrease acid in the stomach can make you more susceptible to C. diff.  

What are the symptoms of C. diff?

Symptoms vary based on how inflamed the colon has become, but can range from slightly loose stools to more than two dozen episodes of diarrhea a day. Abdominal pain and fever can also occur.

In severe cases, C. diff infection can lead to life-threatening dehydration (from loss of fluids due to diarrhea), low blood pressure, a condition called toxic megacolon (an acutely distended colon that requires surgery), and colon perforation. 

How is C. diff diagnosed?

Doctors will suspect C. diff infection when a person develops diarrhea within two months of using an antibiotic. A lab test confirms the diagnosis by looking for one of the toxins produced by C. diff in a stool sample.

Imaging tests such as abdominal X-rays or computed tomography may be done if a serious complication (toxic megacolon or colon perforation) is suspected. 

How is C. diff treated?

C. diff is treated with the very thing that most often causes it—antibiotics. However, if you contract C. diff while on antibiotics, your doctor will likely have you stop the medication you are taking and try a different type.

Many infections respond to treatment—typically with a 10-day course, although some people may need longer. Though it’s not common, surgery to remove the affected portion of the colon may be required to treat complications of serious infections.

Unfortunately, C. diff reinfection is fairly common, occurring in about 20 percent of patients. For those patients, a stronger type of antibiotic may be necessary, or a fecal transplant (using stool transferred from a healthy patient). This method, says Matthew Grant, MD, a Yale Medicine infectious diseases specialist, is often more effective than antibiotics.

How can C. diff be prevented?

To prevent a C. diff infection, you can do the following:

• Avoid the unnecessary use of antibiotics.
• Wash your hands thoroughly for at least 20 seconds with soap and water.
• Clean infected surfaces with disinfectants such as bleach in places where someone is known to have C. diff.
• If you have C. diff, close the lid when flushing the toilet, as the spores can travel through the air. 

What stands out about Yale Medicine’s approach to C. diff?

At Yale Medicine, our physicians are at the forefront of preventing C. diff infections. “We have rolled out a new initiative to prevent the unnecessary prescribing of antibiotics for hospitalized patients, and we are starting to use an antibody that reduces the risk of C. diff relapse,” says Dr. Grant.

Clostridium difficile (C. diff.) Infection: Causes and Risks

What is Clostridium difficile (C. diff.)?

Clostridium difficile (C. diff.) is a type of bacteria that lives in many people’s intestines. C. diff. is part of the normal balance of bacteria in your body. It also lives in the environment, such as in soil, water, and animal feces.

Most people never have problems with C. diff. However, if there is an imbalance in your intestines, C. diff. may begin to grow out of control. The bacteria start to release toxins that irritate and attack the lining of your intestines. This is what leads to symptoms of a C. diff. infection.

Symptoms of C. diff. infection

C. diff. infections can range from mild to severe.

Mild symptoms can include:

• Watery diarrhea (3 or more times each day for several days).
• Stomach pain or tenderness.

Severe symptoms can include:

• Frequent, watery diarrhea (up to 15 times each day).
• Severe stomach pain or tenderness.
• Nausea.
• Loss of appetite
• Low-grade fever of up to 101°F in children or 100°F to 102°F in adults
• Blood or pus in your stool.

Call your doctor if:

• Symptoms begin after taking an antibiotic.
• Symptoms last longer than 3 days or get worse.

What causes a C. diff. infection?

The most common risk factor for C. diff. is the use of an antibiotics. Antibiotics can disrupt the normal balance in your intestines. Your risk increases if you have taken antibiotics for a long period of time or if the antibiotic is broad-spectrum (treats a wide variety of bacteria)..

People who are 65 years of age or older are at greater risk of a C. diff. infection. Other risk factors include:

• Surgery of the gastrointestinal (GI) tract.
• Stomach surgery that requires moving the intestines aside.
• A stay in the hospital.
• Living in a nursing home or extended-care facility.
• Colon problems, such as inflammatory bowel syndrome (IBS) or colorectal cancer.
• Weakened immune system.
• Prior C. diff infection.

If you are in good health, you likely will not get a C. diff. infection

How is C. diff. diagnosed?

Your doctor will need to test a stool sample to diagnose C. diff. Follow-up tests may be needed to confirm. Your doctor may do an X-ray or computerized tomography (CT) scan of your colon.

You can test positive for a C. diff. infection without having any symptoms. This is known as C. diff. colonization. Some people are carriers for C. diff. but do not have C. diff. A positive test result plus symptoms indicate that you have an active C. diff. infection.

Can a C. diff. infection be prevented or avoided?

A C. diff. infection is contagious. The bacteria can spread person to person. They also live a long time on surfaces, such as toilet seats, telephones, and doorknobs. Good hygiene can help you avoid the bacteria.

• Wash your hands often and well, using soap and water.
• Use disposable gloves when caring for someone who may have C.
• Use chlorine bleach-based products to disinfect surfaces and items.
• Wash clothing that may be soiled with stool with soap and chlorine bleach.
• If you visit someone in a health care facility, wash your hands before, during, and after your visit.
• Do not use antibiotics unless your doctor recommends them.

If you have a C. diff. infection, wash your hands with soap and water before eating and after using the restroom. Use a chlorine bleach-based product to clean surfaces you may have touched to avoid spreading the infection to others. About 1 in 5 people who have C. diff. will get it again.

C. diff. infection treatment

If you were taking an antibiotic when your symptoms started, your doctor will probably ask you to stop taking it. They will watch you for dehydration if you have severe diarrhea. About 25% of patients begin to improve 2 to 3 days after they stop the antibiotic that caused the infection.

For severe cases, your doctor may prescribe a 10-day dose of an antibiotic that has proved effective in treating C. diff. infections. Examples include metronidazole and vancomycin. You should improve after 72 hours of starting the medicine, although the diarrhea may continue. In about 15% to 35% of cases, a second round of antibiotics is needed.

While you recover, drink plenty of fluids to replace what your body lost due to diarrhea. Avoid milk products and foods that contain wheat flour or are high in fiber. Your digestive tract may be sensitive to them for a few days.

Living with a C. diff. infection

If your infection gets worse, you may become dehydrated or be unable to pass stool. In rare cases, C. diff. can lead to sepsis (a life-threatening blood infection) or a puncture in your intestines.

If you have diarrhea and think it could be caused by C. diff., check with your doctor before using antidiarrhea medicine. These drugs can make your infection worse.

Certain probiotics, or “good bacteria,” may help prevent repeat C. diff. infections. Talk to your doctor before taking any supplements. They can instruct what to take along with antibiotics.

Questions to ask your doctor

• Should I stop taking my antibiotic? At what point?
• If I have diarrhea, when should I call my doctor?
• How did I get a C. diff. infection?
• What treatment is best for me?
• If I’ve had C. diff once, what is my risk of getting it again?
• My mother is in a nursing home that has a breakout of C. diff. Should she be tested?
• I’ve been diagnosed as a C. diff. carrier. What precautions should I take with my friends and family?
• I have diverticulitis. Am I at risk for a C. diff. infection?

Resources

Centers for Disease Control and Prevention: Clostridium difficile infection information

National Institutes of Health, MedlinePlus: Clostridium Difficile Infections

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“It is possible to firmly resist the coronavirus only through the joint efforts of medicine and the whole society”

– Issues of life and health of people in our country are always in the foreground. In critical moments, this is felt especially. In the first wave of coronavirus, measures were taken at the state level, thanks to which, and the active actions of the healthcare system, we were able to adequately resist the new infection that excited the whole world. Doctors gained experience in the fight against coronavirus, which helped to organize when the second wave began.

The Grodno region was one of the last in the country to experience the first wave of morbidity, and entered the second, as expected, earlier than other regions. And medicine met the new onset of infection fully armed. All the necessary resources were immediately involved. This concerns the re-profiling of hospitals, the readiness of medical personnel, the availability of medicines, equipment, and personal protective equipment. In accordance with a pre-developed plan in case of a rise in the coronavirus, the bed fund was gradually redesigned. In some medical institutions – completely, in others – partially. Reserve beds are also kept in case it is necessary to expand anti-covid hospitals. At the same time, hospitals are always ready to provide emergency and urgent medical care.

Based on the experience of the first wave, the fleet of necessary medical equipment has been increased. The full range of necessary laboratory and diagnostic studies is performed, including computed tomography of the lungs, X-ray diagnostics, testing of COVID infection. In the near future, a modern CT scanner will appear in the Grodno emergency hospital. Similar CT devices are also planned to be purchased and installed in the fourth city clinical hospital in the regional center, as well as in the central district hospitals of Lida and Novogrudok. The polymerase chain reaction method, one of the most accurate methods, detects coronavirus in five laboratories, including in the regions of Lida and Ostrovets. Soon, such work will begin in the Volkovysk Central District Hospital.

Work continues to increase the number of oxygen points, improve gas supply systems. The ventilator equipment, which is in our hospitals, is used only by 11 percent.

In hospitals, there are no questions about the provision of medicines. There are also expensive ones, which are shown when it comes to the threat to people’s lives. These drugs have a very serious effect, therefore, in each individual case, the decision to prescribe them is made at a council with the participation of the most experienced specialists.

Enough personal protective equipment. Each medical institution has their monthly supply. A so-called reserve fund has been created in the regional infectious diseases hospital. In the health department, these issues are under special control. After all, this is very important for those who are at the forefront of the fight for the health of all people today.

I want to say thank you to all the medical workers of the Grodno region. First of all, thanks to them, the assistance system works clearly and smoothly, the importance of which today can hardly be overestimated. Often they do the almost impossible, bordering on a miracle – they give people a second birthday.

There are some positive changes in the general situation. Today, the region is experiencing stabilization of the situation with pneumonia as the most severe form of complication of coronavirus infection. However, the period of rise in acute respiratory diseases and coronavirus infection has not yet passed, it is predicted to be longer, so no one is allowed to relax. Neither the health care system, nor society, nor each resident of the region individually.

I would like to emphasize that how the epidemiological situation will develop further depends not only on medicine, but also on people’s behavior. It depends on how everyone follows prevention recommendations: adhere to the principle of social distancing, use a mask when in public places, carry out hand hygiene, observe respiratory etiquette. As well as from the heads of enterprises and organizations – to what extent in labor collectives, when interacting with visitors, recommendations will be followed to minimize the risk of the emergence and spread of COVID-19. The introduction of a mask regime when visiting public places and crowded places in all districts of the region is not someone’s whim, but an important protective measure.