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OVERVIEW

What is Clostridium difficile?

Clostridium difficile (C. diff) is a type of bacteria that lives in many people’s intestines. C. diff. is part of the normal balance of bacteria in your body. It also lives in the environment, such as in the soil, water and in animal feces.

Most people never have problems with C. diff. However, if there is an imbalance in your intestines, C. diff. may begin to grow out of control. The bacteria start to release toxins that attack the lining of the intestines. This is what leads to symptoms of C. diff. infection.

SYMPTOMS

What are the symptoms of C. diff. infection?

C. diff. infections can range from mild to severe.

Mild symptoms can include:

• Watery diarrhea (3 or more times each day for several days)
• Stomach pain or tenderness

Severe symptoms can include:

• Frequent, watery diarrhea (up to 15 times each day)
• Severe stomach pain or tenderness
• Nausea
• Loss of appetite
• Low-grade fever of up to 38.3°C (101°F) in children or 37.8°C to 38.9°C (100°F to 102°F ) in adults
• Blood or pus in the stool

CAUSES & RISK FACTORS

What causes a C. diff. infection?

The most common risk factor for C. diff. is the use of an antibiotics. Antibiotics can disrupt the normal balance in your intestines. Your risk increases if you have taken antibiotics for a long period of time or if the antibiotic is broad-spectrum (treats a wide variety of bacteria).

People who are 65 years of age or older are at greater risk of a C. diff. infection. Other risk factors include:

• Surgery of the gastrointestinal (GI) tract
• Abdominal surgery that requires moving the intestines aside
• A stay in the hospital
• Living in a nursing home or extended-care facility
• Colon problems, such as inflammatory bowel syndrome (IBS) or colorectal cancer
• Impaired immune system
• Previous C. diff. infection

If you are in good health, you likely will not get a C. diff. infection

DIAGNOSIS & TESTS

How is C. diff. diagnosed?

Your healthcare provider will need to test a stool sample to diagnose C. diff. Follow-up tests may be needed to confirm. Your healthcare provider may do an X-ray or computerized tomography (CT) scan of your colon.

You may test positive for C. diff. without having any symptoms. This is known as C. diff. colonization. Some people are carriers for C. diff. but do not have C. diff. infection. A positive test result plus symptoms indicate that you have an active C. diff. infection.

PREVENTION

Can a C. diff. infection be prevented or avoided?

A C. diff. infection is contagious. The bacteria can spread person to person. They also live a long time on surfaces, such as toilet seats, telephones, and doorknobs. Good hygiene can help you avoid the bacteria

• Wash your hands often and well, using soap and water.
• Use disposable gloves when caring for someone who may have C. diff.
• Use chlorine bleach-based products to disinfect surfaces or items
• Wash clothing that may be soiled with stool with soap and chlorine bleach.
• If you are visiting someone in a healthcare facility, wash your hands before, during and after your visit
• Don’t use antibiotics unless your healthcare provider recommends them.

If you have C. diff. infection, wash your hands with soap and water before eating and after using the restroom. Use a chlorine bleach-based product to clean surfaces you may have touched to avoid spreading the infection to others.

TREATMENT

How is C. diff. infection treated?

If you were taking an antibiotic when your symptoms started, your healthcare provider will probably ask you to stop taking it. You may be watched for dehydration if you have had bouts of severe diarrhea. About 25% of patients show improvement 2 to 3 days after they stop taking the antibiotic that was causing C. diff. infection.

For more serious cases, your healthcare provider may prescribe a 10-day dose of an antibiotic that has proved effective in treating C. diff. infection, such as metronidazole or vancomycin. You should improve after 72 hours of starting the medicine, although the diarrhea may continue. In about 15% to 35% of cases, another round of antibiotics is needed.

While you recover, drink plenty of fluids to replace what your body lost due to diarrhea. Avoid milk products and foods that contain wheat flour or are high in fiber. Your digestive tract may be sensitive to them for a few days.

Living with a C. diff. infection

If your infection gets worse, you may become dehydrated or be unable to pass stool. In rare cases, C. diff. can lead to sepsis (a serious infection that spreads through the blood) or a puncture in your intestines.

If you have diarrhea and think it could be caused by C. diff., check with your healthcare provider before using antidiarrheal medicine. These drugs can make your infection worse.

Certain probiotics, or “good bacteria,” may help prevent repeat C. diff. infections. Talk to your healthcare provider before taking any supplements. They can instruct what to take along with antibiotics.

FOR MORE INFORMATION

Nova Scotia Department of Health and Wellness Website
https://novascotia.ca/dhw/CDPC/c-difficile.asp

Public Health Agency of Canada Website
https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html