Clostridium Difficile Infection

What is Clostridium difficile infection?

Clostridium difficile is a type of bacteria that lives in the intestines. Healthy people can have some of these bacteria in their colon without getting sick. However, if you have too many clostridium difficile bacteria, they can damage the colon and cause a serious, even life threatening, infection.

These bacteria are also called C. difficile or C. diff.

What is the cause?

You may get a C. diff infection if you have been taking antibiotics for a while. Different antibiotics kill different kinds of bacteria. Antibiotics can upset the natural balance of "good" and "bad" bacteria in your gut. When an antibiotic kills 1 type of bacteria, this may let too many other bacteria grow in your gut. If you have too many C. difficile bacteria you may develop an infection.

You are also more likely to get a C. diff infection if:

• You have a health problem that weakens your immune system, such as diabetes or cancer.
• You are 65 or older.
• You live in a long-term care facility.
• You have a history of colon problems, such as colorectal cancer or colitis.

What are the symptoms?

The most common symptoms of C. diff infection are

• watery diarrhea, which may be bloody
• fever
• loss of appetite
• nausea
• belly pain and tenderness.

How is it diagnosed?

The infection is diagnosed with tests of bowel movement samples. The tests can show the kind of bacteria causing the infection. Tests called cultures can show which antibiotics are best to treat the infection.

You may have the following tests to see if the infection is damaging your colon:

• special X-rays, such as a CT scan of your belly
• sigmoidoscopy or colonoscopy, which uses a thin, flexible lighted tube to look at the lining inside the colon

How is it treated?

Even though antibiotics may have caused the C. diff infection, you will need more antibiotics to get rid of it. C. diff infections are usually treated with metronidazole or vancomycin. However, some strains of C. difficile are getting resistant to these antibiotics. This means that the medicines no longer kill the bacteria. A newer antibiotic called fidaxomicin (Dificid) may be used to treat C. diff infections that are resistant to the other antibiotics. Your provider will use culture test results to look for an antibiotic that will work.

If the lining of your colon has been badly damaged by the infection, you may need surgery to remove the injured part of the colon.

If you are hospitalized, you may need to stay by yourself in a single room. This is to help make sure the bacteria stay in your room and don’t contaminate or infect other people.

How can I help take care of myself?

• Follow your healthcare provider’s recommendations carefully. Take your medicine exactly as it is prescribed. Do not take half doses and do not stop before you have taken all of the medicine.
• If you have diarrhea, ask your provider for a recommended diet. This often includes:
  • Eat starchy foods, such as potatoes, bread, pasta, bananas, and boiled vegetables.
  • Avoid caffeine.
  • Drink apple juice or other nonacidic juices. Avoid citrus drinks.
• Ask your provider if you should take acetaminophen for your fever and stomach pain.
• If your diarrhea is bloody, don’t take aspirin or other anti-inflammatory medicine, such as ibuprofen and naproxen. These medicines can cause stomach problems, as well as other problems. They can make the bleeding worse. These risks increase with age. If you are taking these medicines, read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days for any reason.
• Be sure you drink plenty of liquids, especially if you have diarrhea.
• Clean your hands often. When you are at home, the people who live with you should also clean their hands often.
• If you are at home, you should call your healthcare provider right away if:
  • Your fever is getting higher.
  • Your fever stays at 100.5°F (38°C) or higher for more than 2 days after you start treatment.
  • Your diarrhea is getting more frequent.
  • You have more blood in your diarrhea.
  • Your stomach cramps and pain are getting worse instead of better.
  • You are too sick to drink enough liquids.
  • You are making very little urine and the urine is dark yellow.
• If you have any questions about your symptoms, call your healthcare provider.

How can I prevent C. difficile infection?

If you have C. difficile, you can avoid passing it to others by cleaning your hands well with soap and water or an alcohol-based hand rub. Everyone who comes into your room must also clean their hands before and after seeing you. This includes doctors, nurses, other staff, and visitors.

If you are being treated at the hospital for C. diff infection, you may need to stay in your room. If you are allowed to leave your room, you should not go to common areas, such as the gift shop or cafeteria. You can go to other areas of the hospital for treatments and tests. Usually the staff caring for you will wear protective gowns and gloves, which they will take off before leaving your room. Visitors may also need to wear gloves and a gown over their clothing. The housekeeping staff must also use gowns and gloves when entering your room and should clean all surfaces in the hospital room, including the bedrails and the telephone.

If you do not have C. difficile but want to avoid getting it, you should:

• Wash your hands every time you use the bathroom and every time before you have a snack or eat a meal.
• Take antibiotics only when necessary and as prescribed by your healthcare provider.
• If you are being treated at a hospital, make sure that all doctors, nurses, and other healthcare providers clean their hands with soap and water or an alcohol-based hand rub before and after caring for you. If you do not see your providers clean their hands, ask them to do so.

If you are at high risk for infection, you may be given medicine that may help you have a healthy balance of bacteria in your colon.