Clostridium difficile

Clostridium difficile, the life-threatening bacterium that causes diarrhea and more serious intestinal conditions, is sickening many more patients than previously estimated, according to a 2008 study released by the Association for Professionals in Infection Control and Epidemiology (APIC).

“The National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilities” indicates that 13 out of every 1,000 hospitalized patients were either infected or colonized with C. difficile. Based on this rate, it is estimated that there are at least 7,178 patients hospitalized on any one given day in American healthcare institutions, costing the US healthcare system between $17.6 and $51.5 million.

What is C. difficile?
Clostridium difficile [klo-STRID-ee-um dif-uh-SEEL], or C. difficile, is a potentially life-threatening bacterium found in the intestines that can cause diarrhea and more serious intestinal conditions such as colitis (inflammation of the large intestine).

According to the Centers for Disease Control and Prevention (CDC), C. difficile infection (CDI) appears to be increasing rapidly in the United States and is disproportionately affecting older persons. CDI is a major worldwide cause of hospital-associated diarrhea with the CDC estimating that it affects as many as 500,000 people in the United States annually.

What are the symptoms of CDI?
The symptoms of C. difficile infection include watery diarrhea (at least three bowel movements per day for two or more days), fever, loss of appetite, nausea, abdominal pain/tenderness and abdominal cramping.
 
Treatment. Treatment may necessitate discontinuing your present antibiotic, if you are taking one. It is generally treated for 10 days with specific medications that will be prescribed by your healthcare provider. The drugs are effective and appear to have few side effects. 

Who is at risk for CDI?
C. difficile infection rarely occurs in healthy people. Individuals who have other illnesses or conditions requiring prolonged use of antibiotics and the elderly are at greater risk of acquiring this disease. Antibiotics can kill good bacteria as well as bad, often upsetting the natural balance in the body. C. difficile may flourish after antibiotic use because that balance is upset.

The risk for disease increases in patients with:

• antibiotic exposure
• gastrointestinal surgery/gastrointestinal procedure
• long length of stay in healthcare settings
• a serious underlying illness
• conditions that weaken the immune system
• advanced age
• previous C. difficile infection 

The C. difficile bacteria are found in the feces. The bacteria are spore forming which makes them more difficult to kill than other bacteria. People can become infected if they touch items or surfaces that are contaminated with feces or the spores and then touch their mouth or mucous membranes. Healthcare workers can spread the bacteria to other patients or contaminate surfaces through hand contact.

How do you protect against CDI?
If you are infected, you can spread the disease to others. However, only people who are hospitalized or on antibiotics are likely to become ill. You may do the following to reduce the chance of spread to others:

• Wash hands with soap and water after using the restroom and before eating.
• Clean surfaces in bathrooms, kitchens and other areas on a regular basis with household detergent/disinfectants. A bleach solution of 1 cup bleach to 10 cups of water can be used daily to clean and prevent spread of the bacteria (mix daily).
• Do not share the toilet with other persons. If this is not possible to do, then wipe with the bleach solution after use by the person with C. difficile infection. Do not forget to wipe the toilet handle.

In addition to good hand hygiene, another important safety tip is reducing the unnecessary use of antibiotics. Don’t demand antibiotics for every cold and sniffle, as these are almost always caused by viruses. Viruses are not affected by antibiotics. Ask your healthcare provider if antibiotics are necessary, and if they are prescribed, be sure to take the full course exactly as directed.

Please see the following sources for additional information:
CDC: General Information about Clostridium difficile Infections
CDC: Overview of Clostridium difficile Infections
APIC: National U.S. Inpatient Healthcare Facility Clostridium difficile Survey