C. difficile infection
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Clostridioides difficile, commonly referred to as C. difficile or C. diff, is responsible for causing colon infections. This infection can lead to a range of symptoms, including diarrhea and, in severe cases, even colon injury, posing a significant life-threatening risk. It’s worth noting that the bacterium was previously known as Clostridium difficile.
C. difficile infections typically occur following the use of antibiotics. While older individuals in hospitals or long-term care centers are commonly affected, these infections can also afflict people who are not in healthcare facilities. Additionally, certain strains of the bacterium found in the general population have a higher propensity to harm younger people or lead to severe infections.
The majority of colon bacterial infections are not dangerous and are quite common. However, a C. difficile infection might be more destructive to your intestines and more aggressive. It can result in pseudomembranous colitis, a severe form of colitis.
When certain antibiotics target and eliminate the beneficial bacteria in your gut but spare C. difficile, it creates an opportunity for C. difficile to rapidly proliferate. To effectively combat C. difficile infection, an alternative antibiotic to treat C. difficile is necessary.
Symptoms
Certain individuals can carry C. difficile bacteria in their intestines without experiencing any illness. However, these asymptomatic carriers could potentially spread the bacteria and cause infections in others.
Usually, signs and symptoms of C. difficile infection emerge approximately 5 to 10 days after initiating an antibiotic treatment. Nevertheless, they might manifest as early as the first day or as late as three months after starting the antibiotic course.
Mild to moderate infection
The following are the most typical symptoms and indicators of a mild to moderate C. difficile infection:
- Minimal discomfort and cramps in the abdomen
- Three or more times each day for more than one day, watery diarrhea
Severe infection
Severe C. difficile infections often lead to dehydration, which necessitates hospitalization. Due to C. difficile, the colon may become inflamed and may develop raw tissue patches that may bleed or generate pus. Indicators of a serious infection include:
- 10–15 episodes of watery diarrhea each day
- Potentially severe cramps and pain in the abdomen
- Fever
- Nausea
- Renal failure
- Appetite loss
- Dehydration
- Abdominal swelling
- Losing weight
- Stool contains pus or blood
- Increased heart rate
- Elevated white blood cell count
Acute and severe C. difficile infection may also result in intestinal inflammation, which can expand the colon (toxic megacolon) and induce sepsis. When the body reacts to an infection by damaging its own tissues, it develops sepsis, a condition that poses a serious risk to life. The intensive care unit accepts patients with certain conditions.
Some people experience loose stools when taking antibiotics or right afterward. An infection with C. difficile may be the cause of this. Consult a physician if you have:
- Recent fever
- At least three watery stools every a day
- Long-lasting symptoms (greater than two days)
- The stool has a presence of blood
- Severe cramping or pain in the abdomen
Causes
The body is exposed to C. difficile germs through the mouth. The small intestine is where they can start replicating. They can produce toxins that harm tissue when they get to the colon. These toxins cause watery diarrhea, cell death, and patches of inflammatory cells and cell debris.
When C. difficile bacteria exist outside of the colon, they essentially enter a dormant state, rendering them inactive in almost any environmental setting. Due to this characteristic, they have the ability to survive for extended periods in various locations, including:
- Hands(unwashed)
- Soil
- Water
- Human stool
- Animal stool
- Food, including meat
- Room surfaces
Once dormant C. difficile bacteria find their way back into someone’s digestive tract, they can “awaken” and resume causing infections. The bacterium is easily spread, particularly when dormant, as it can persist outside the body, especially in the absence of thorough hand washing and proper cleansing practices.
Risk factors
Despite the fact that C. difficile has caused illness in adults with no known risk factors, certain conditions raise the risk.
Taking antibiotics or other medications
Within your intestines, there exist approximately 500 to 2,000 different types of bacteria, totaling around 100 trillion microorganisms. Many of these bacteria play a vital role in safeguarding your body against infections. However, when antibiotics are used to treat an infection, they can inadvertently kill some of these beneficial bacteria along with the harmful ones.
C. difficile can rapidly multiply and become problematic if there aren’t enough beneficial bacteria to keep it in check. While any antibiotic can potentially be involved, the ones that most frequently lead to C. difficile infections are penicillins, fluoroquinolones, clindamycin, or cephalosporins.
Your chance of contracting C. difficile infection may also be increased by proton pump inhibitors, a class of medication used to lower stomach acid.
Residing in a medical facility
The majority of C. difficile infections occur in individuals who are currently in or have recently been in a healthcare facility, such as hospitals, nursing homes, or long-term care facilities. These settings are more prone to rapid spread of infections due to factors like widespread antibiotic usage and patients being more vulnerable to infections.
C. difficile can spread within hospitals and elderly homes through various means, including contact with furniture or gadgets like stethoscopes, thermometers, telephones, remote controls, cart handles, as well as through contact with hands, toilets, sinks, bedrails, and bedside tables.
Undergoing a medical procedure or serious sickness
You may be more vulnerable to developing a C. difficile infection if you have certain medical problems or have certain procedures, such as:
- Chronic kidney disease
- Gastrointestinal procedures
- Inflammatory bowel disease
- Immune system compromised by a disease or medication (such as chemotherapy)
- Other surgical intervention in the abdomen
Other risk factors
A danger factor is getting older. According to one study, those 65 and older had a 10-fold higher risk of contracting C. difficile infection than younger people.
The likelihood of developing a subsequent C. difficile infection rises with each infection, and the risk keeps rising.
For reasons that are not entirely known, women are more likely than men to get a C. difficile infection.
Diagnosis
A C. difficile infection is determined by the existence of:
- Diarrhea
- Detection of C. difficile in stool
- Other C. difficile infection signs and symptoms
Testing for C. difficile infection should not be done on those who have regular, well-formed feces. It is not necessary to have recently taken antibiotics in order to diagnose C. difficile infection.
Stool tests
Your doctor will request one or more stool sample laboratory tests if C. difficile infection is suspected. These tests either pinpoint the toxin or the bacterial strains that create it.
Colon examination
In certain cases, a doctor may conduct an internal examination of your colon to confirm a diagnosis of C. difficile infection and to investigate other potential causes of your symptoms. This examination, also referred to as a flexible sigmoidoscopy or colonoscopy, involves inserting a flexible tube with a small camera on one end into your colon. The purpose of this procedure is to examine the colon for any abnormal tissue or inflammatory lesions that may provide further insights into your condition.
Imaging tests
Your doctor might request an abdominal X-ray or a computerized tomography (CT) scan, which produces images of your colon, if they are worried about potential C. difficile infection consequences. The scan has the ability to identify issues like:
- Bowel enlargement
- Perforation in your colon’s lining
- Colon wall thickening
Treatment
Treatment is administered only to individuals who show signs or symptoms of illness. Those who have the bacterium but are otherwise healthy and do not exhibit any symptoms are not given any treatment.
Antibiotics
If your C. difficile infection is linked to the antibiotic you are taking, your doctor will likely discontinue its use. However, in cases where antibiotic therapy is necessary to treat another infectious disease, your doctor may prescribe an alternative medication that is less likely to cause diarrhea triggered by C. difficile infection.
The primary treatment for C. difficile infection involves the use of antibiotics. Commonly prescribed antibiotics for this condition include fidaxomicin and vancomycin. In cases of severe C. difficile infections, a combination of vancomycin and metronidazole can be utilized for treatment.
Surgery
In some circumstances, including the following, surgery to remove the diseased part of the colon may be required.
- Organ failure
- Toxic megacolon
- Extreme pain
- The abdominal wall lining is inflamed
Treatment for recurrent infection
A quarter of those who have had C. difficile infections treated get sick again, either because the original infection persisted or because they have been exposed to a new strain of the bacteria. With each bout of C. difficile infection, the risk rises, exceeding 50% after three or more infections.
If any of the following apply to you:
- Age more than 65
- Have a major underlying illness, like inflammatory bowel disease, chronic liver disease, or chronic kidney failure.
- Are receiving treatment for a C. difficile infection while also taking antibiotics for a separate disease.
The following methods may be used to treat recurrent illness.
- Antibiotics. One or more courses of a medicine may be used as part of an antibiotic therapy regimen for recurrent infections. The medications are typically not the same kind of antibiotics that were previously utilized. With each consecutive recurrence, antibiotic therapy becomes less effective.
- Antibody-based therapy. Human antibody against the C. difficile toxin B, bezlotoxumab, is a treatment that has been found to lower the risk of recurrent C. difficile infection in people who are at a high risk of recurrence.
- Fecal Microbiota Transplant (FMT). FMT has been researched in clinical trials as a potential treatment for many recurring C. difficile infections. Although the U.S. Food and Drug Administration has not approved FMT, it may be used as an experimental technique for C. difficile infection. You must sign a consent form that details the procedure’s advantages and disadvantages. FMT is often referred to as an intestinal microbiota transplant or a stool transplant.
By using specialized tubes that are introduced via your rectum, FMT replaces healthy intestinal bacteria in your colon. Before being utilized for FMT, donors are rigorously screened for medical issues, their blood is examined for infections, and their feces are checked for parasites, viruses, and other infectious germs.
According to studies, FMT performed once or more times has a greater than 85% success rate in treating recurrent C. difficile infections.
- Probiotics. Probiotics, which are supplements or foods containing beneficial microorganisms, are intended to support the stability and growth of the body’s “good” bacteria. However, their role in contributing to C. difficile infections remains a subject of debate. The effectiveness of existing probiotic products in preventing or treating C. difficile infections has not been consistently demonstrated through research. While advanced probiotics are still under investigation, they are not currently available for the treatment or prevention of C. difficile infections. Researchers continue to explore their potential utility in this regard.
