Overview
C. difficile, also known as Clostridioides difficile or C. diff, is a type of bacterium that can cause an infection in the colon, the longest part of the large intestine. Symptoms of the infection can range from mild diarrhea to severe damage to the colon. The bacterium often occurs after using antibiotic medications, and it primarily affects older adults in hospitals or long-term care settings. However, it can also affect people outside of healthcare settings, with some strains being more likely to affect younger individuals. C. difficile infections can be spread through contact with contaminated surfaces or by carriers who do not show symptoms but still have the bacteria in their intestines. Risk factors for C. difficile infections include the use of certain antibiotics, inflammatory bowel disease, a weakened immune system, and certain medical procedures or treatments.
Understanding the disease
Symptoms
The symptoms of C. difficile infection can range from mild to severe. For mild to moderate infections, common symptoms include watery diarrhea three or more times a day for more than one day, mild belly cramping and tenderness. For severe infections, symptoms may include watery diarrhea as often as 10 to 15 times a day, severe belly cramping and pain, fast heart rate, loss of fluids (dehydration), fever, nausea, increased white blood cell count, kidney failure, loss of appetite, swollen belly, and weight loss.
Risk Factors
The risk factors for developing C. difficile (clostridioides difficile) infection include:
- Taking antibiotics or other medicines: Antibiotics can kill helpful bacteria in the gut, allowing C. difficile to overgrow and cause infection. Specific antibiotics that commonly lead to C. difficile infection are clindamycin, cephalosporins, penicillins, and fluoroquinolones. Taking proton pump inhibitors, which reduce stomach acid, may also increase the risk.
- Staying in a healthcare setting: C. difficile infections are more common in hospitals, nursing homes, and long-term care facilities where germs spread easily, antibiotic use is common, and people's health puts them at high risk of infection.
- Having a serious illness or medical procedure: Certain medical conditions or procedures that weaken the immune system or disrupt the gut's normal bacteria balance can increase the risk, such as inflammatory bowel disease, weakened immune system from medical conditions like chemotherapy, and procedures on the digestive tract or other surgery in the stomach area. To prevent C. difficile infection, avoid unnecessary antibiotic use, follow proper hand hygiene, and maintain cleanliness in healthcare settings.
Assessment and Diagnosis
Triage
If you suspect C. difficile infection, it is advisable to consult a healthcare provider. Symptoms of mild to moderate infection include watery diarrhea three or more times a day for more than one day, mild belly cramping and tenderness. For severe infection, symptoms may include watery diarrhea as often as 10 to 15 times a day, severe belly cramping and pain, fast heart rate, fever, nausea, increased white blood cell count, kidney failure, loss of appetite, swollen belly, and weight loss. Seek medical attention if you experience these severe symptoms or if your condition worsens. It is important to seek medical advice promptly, as C. difficile infections can quickly progress and become life-threatening if not treated promptly.
Diagnosis
A diagnosis of C. difficile infection is based on having diarrhea and other symptoms of C. difficile infection, as well as the presence of C. difficile in a stool sample. Stool tests can show either the toxins or strains of the bacteria that produce toxins. However, people who have regular, formed stools should not be tested for C. difficile infection. To confirm the diagnosis, a health care provider might perform a colon exam using flexible sigmoidoscopy or colonoscopy, which involves inserting a flexible tube with a small camera on one end into the colon to look for problem areas. Imaging tests, such as an X-ray of the stomach area or a CT scan, can also be used to detect complications of C. difficile infection, including a thickened colon wall, enlarged bowel, or a hole in the lining of the colon. Treatment for C. difficile infection typically involves antibiotics, such as vancomycin, fidaxomicin, or metronidazole, depending on the severity of the infection and the patient's condition. In some cases, surgery may be necessary to remove the diseased part of the colon.
Management and Treatment
Complications
Complications of C. difficile infection can include loss of fluids (dehydration), severe diarrhea, electrolyte imbalances, kidney failure, and death, even with mild to moderate infections. Other possible complications may include the recurrence of pseudomembranous colitis after successful treatment.
Prevention
C. difficile can be prevented by following certain precautions. The measures to prevent the spread of C. difficile include:
- Hand-washing: Ensuring that hands are clean before and after treating a person or leaving a hospital or healthcare setting.
- Contact precautions: Isolating people with C. difficile infections in private rooms or sharing rooms with others who have the same illness. Hospital staff and visitors should wear disposable gloves and isolation gowns while in the room.
- Thorough cleaning: Using disinfectant products that contain chlorine bleach to clean surfaces in healthcare facilities.
- Use antibiotics only when necessary: Avoiding the use of antibiotics unless they are truly necessary, and asking for shorter-term or narrow-spectrum antibiotics when prescribed. Antibiotics should not be taken for viral illnesses. Remember to follow these guidelines and encourage healthcare facilities to adhere to infection-control measures to help prevent the spread of C. difficile.
Preparing for medical consultation
To prepare for an appointment for C. difficile, follow these steps:
- Be aware of any pre-appointment restrictions: Ask your healthcare provider if there are any specific instructions you need to follow before the appointment, such as fasting or avoiding certain medications.
- Write down your symptoms: Make a list of any symptoms you are experiencing, including diarrhea, abdominal pain, fever, and nausea. Note when they started and how severe they are.
- Gather medical history: Prepare a list of any previous medical conditions or illnesses, medications you're currently taking, and any recent hospitalizations or surgeries.
- Write down key personal information: Include any recent travel, changes in your daily routine, or exposure to other people with similar symptoms.
- Make a list of medications, vitamins, and supplements: Bring a list of all the medications, vitamins, and supplements you are currently taking, including any over-the-counter medications.
- Consider bringing a family member or friend: It can be helpful to have someone with you to ask questions, remember important information, and provide emotional support.
- Prepare a list of questions: Write down any questions you have for your healthcare provider, including concerns about your symptoms, possible diagnosis, and treatment options. Remember to inform your healthcare provider about any recent antibiotic use, as this can increase the risk of C. difficile infection. Follow your healthcare provider's instructions for testing and treatment.