Clostridium difficile

Clostridium difficile, often referred to as C. difficile, is a bacterium that lives in the intestine. It infects the colon walls, causing health problems of varying severity. About 5% of the population carries C. difficile without ever experiencing any symptoms. It is the most widespread infection in Canadian hospitals and the leading cause of infectious diarrhea in hospitalized patients

Causes

C. difficile is found in feces. It is commonly spread by infected persons through hand contact. Direct contact (handshake, for example) contributes to spreading the bacteria. Given that C. difficile can live in the environment, any surface or object can harbour the bacteria (door knob, phone, etc.), thereby contaminating those who come into contact with infected surfaces.

The C. difficile bacterium is usually kept in check by other bacteria that live in the intestine and promote intestinal health. The normal bacterial flora in the intestine helps prevent C. difficile from multiplying and causing infection. Taking antibiotics however, disturbs and reduces the bacteria normally found in the intestine, allowing C. difficile to multiply and increase its presence. As it multiplies, C. difficile produces a toxin that causes diarrhea in those who are infected.

Persons at Risk

Hospitalized individuals are among those who present the highest risk of contamination. Persons using antibiotics for any length of time or taking certain medications for stomach disorders also have a greater risk for infection. Healthy people are not usually vulnerable.

Symptoms

The symptoms of C. difficile are many. The most common ones are:

  • Watery diarrhea (at least 3 bowel movements a day for two or more days)
  • Fever
  • Stomach cramps
  • Loss of appetite
  • Nausea
  • Abdominal pain and tenderness
  • Blood, mucus or pus in stool (occasionally)
  • Nauseous stools

In rare cases, complications (serious intestinal inflammation, dehydration and colitis) can be fatal.

Diagnosis

Diagnosis is made by a physician who will determine whether treatment is required. The doctor may ask you questions about recent antibiotic treatments and may prescribe a cell culture test if deemed necessary.

Treatment

When possible, discontinuing antibiotics is the first consideration. Treatment then involves taking a specific antibiotic to eliminate C. difficile.

Prevention

To prevent the spread of C. difficile, proper hand washing techniques are essential. Hands must be washed with soap and water in order to eliminate mechanically most of bacteria and spores from contaminated hands. If you can not have access to soap and water, the use of alcohol-based hand rubs is then recommended. However, be aware that these preparations are less effective as they do not destroy C. difficile spores. Another important step to preventing transmission involves disinfecting an infected person's surroundings. The use of a diluted bleach solution (1 part bleach for 10 parts water) is recommended to sanitize all objects that an infected person may have come into contact with. Another key to preventing the spread of C. difficile is to frequently wash the infected person's clothing and bedding.

If taking antibiotics, it may be suggested that you take probiotics. Probiotics help regenerate the normal bacterial flora that protects the intestine, which may reduce the risk of C. difficile infection. The effectiveness of this combination however, is not wholly accepted by the scientific community.

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