Clostridium difficile, also called C. difficile or C. diff, is a gram-positive anaerobic bacteria. In humans, it can cause infection by secreting toxins into the lower intestines, or colon. Symptoms of infection include fever and diarrhea. The best Clostridium difficile treatment depends upon the severity of infection and ranges from simply observing the patient to hospitalization and treatment with antibiotics.
Sometimes, patients may simply be colonized with C. diff and not exhibit any symptoms of infection. The most common reason an infection develops is recent treatment with antibiotics. Antibiotics kill the natural bacteria flora in the lower intestines, allowing C. diff to multiply. Other risk factors include current or recent hospitalization, residing in a long-term care facility such as a nursing home, and decreased immunity, such as occurs following chemotherapy. Disorders of the lower intestines, such as ulcerative colitis and Crohn’s disease, can also increase the risk of a C. diff infection.
Clostridium difficile is shed in the feces of an infected or colonized person, then spreads to food, objects, and/or surfaces when that person does not wash his hands properly. The spores can live on many surfaces, such as telephones, counter tops, and floors, for many weeks. C. diff is then spread to another person when he or she touches a contaminated surface. In the United States, it is primarily spread by health care providers who touch a contaminated surface, then examine or care for a patient.
The symptoms of mild infection are watery diarrhea more than three times a day and a low grade fever. Mild abdominal pain and cramping may also occur. The best treatment for mild infection is to stop the implicated antibiotics. This usually resolves symptoms within several days.
The symptoms of more severe infection are caused when the toxins lead to inflammation of and damage to the lining of the colon. This results in watery diarrhea as often as 10 to 15 times per day, elevated white blood cell count, and fever often higher than 102 degrees Fahrenheit (38.9 Celsius). Blood in the stool and severe abdominal pain and cramping also often accompany severe infections. If untreated, severe infection can lead to intestinal perforation and death.
Clostridium difficile treatment of severe infection requires antibiotics for at least ten days. Oral antibiotics are preferred because C. diff remains in the colon and does not go into the bloodstream. The drugs of choice are metronidazole, vancomycin, or teicoplanin. If patients cannot tolerate oral antibiotics, intravenous metronidazole can be given. Commonly used antidiarrheals should be avoided, as they may cause the patient to retain the toxin within the colon.
About one-fourth of patients will have recurrent infection and require additional Clostridium difficile treatment. This usually occurs because the spores have not been eradicated and is not usually due to antibiotic resistance. If recurrent infection occurs, patients are most often re-treated with antibiotics for up to six weeks.
Patients with several episodes of infection are candidates for adjunctive therapies. Probiotics may be taken to prevent overgrowth of C. diff by replenishing bacterial flora in the intestines. Cholestyramine is an oral drug that can be taken to bind the toxins. Finally, intravenous immune globulin can be given to provide the patient with antibodies against the C. diff bacteria. This is a costly therapy most often reserved for critically ill patients.
The best Clostridium difficile treatment is actually prevention. Antibiotics should only be used when truly indicated. Hand washing with soap and water prevents the spread of C. diff from patient to patient. In hospitals, patients suspected of having an infection are often put in special isolation rooms. Finally, any re-usable equipment and surfaces in hospitals and long-term care facilities should be cleaned and disinfected appropriately after each use.