Clostridioides difficile, commonly known as C. diff, is a bacterium that primarily affects the colon. It is a frequent cause of healthcare-associated infections, leading to symptoms that can range from mild diarrhea to severe, life-threatening inflammation of the large intestine.
Understanding Clostridioides difficile
Clostridioides difficile is a Gram-positive, spore-forming anaerobic bacterium. This means it can exist in a dormant, highly resilient spore form and thrives in environments without oxygen, such as the human gut. While often found harmlessly in the human digestive system, it becomes problematic when its numbers increase significantly.
C. diff produces toxins. Specifically, it releases enterotoxin A and cytotoxin B, which damage the cells lining the intestinal wall. This cellular damage leads to inflammation of the colon, known as colitis, and results in the symptoms associated with C. diff infection.
How C. diff Infections Occur
C. diff infections arise when the natural balance of bacteria in the gut, known as the gut microbiota, is disrupted. Antibiotic use is a primary factor in this disruption, as antibiotics can eliminate beneficial bacteria that normally keep C. diff in check, allowing it to multiply and produce toxins.
Transmission occurs when individuals ingest C. diff spores, often through the fecal-oral route. These spores are resistant to heat, acid, and many common disinfectants, allowing them to survive on surfaces for extended periods. Healthcare settings, such as hospitals and long-term care facilities, are common environments for C. diff transmission due to the frequent use of antibiotics and the presence of contaminated surfaces.
Identifying C. diff Symptoms
Symptoms of a C. diff infection vary in severity. The most common symptom is watery diarrhea, which may occur three or more times a day for over a day. This diarrhea can range from mild to very frequent, sometimes up to 10 to 15 times daily in more severe cases.
Along with diarrhea, individuals may experience abdominal cramping and pain, fever, nausea, and a loss of appetite. In severe instances, C. diff can lead to complications such as dehydration, a rapid heart rate, and pseudomembranous colitis, which can be life-threatening.
Diagnosing and Treating C. diff
Diagnosing a C. diff infection involves laboratory tests on a stool sample. These tests detect either the C. diff toxins (A and B) or the genetic material of the bacteria. Molecular tests, such as polymerase chain reaction (PCR), are highly sensitive and identify toxin-producing C. diff organisms. Healthcare providers may also use antigen tests or a two-step approach for diagnosis.
Treatment usually begins by discontinuing the antibiotic that initially disrupted the gut flora, if medically appropriate. Specific antibiotics are then prescribed to target C. diff, with oral vancomycin and fidaxomicin being common choices. For recurrent infections, fecal microbiota transplantation (FMT) is an advanced treatment option. FMT involves introducing stool from a healthy donor to restore a balanced gut microbiome, showing high success rates.
Preventing C. diff Spread
Preventing C. diff spread involves several practices. Thorough hand hygiene with soap and water is effective, as alcohol-based sanitizers are less effective against C. diff spores. Hands should be washed vigorously for at least 15 seconds.
Judicious antibiotic use is important, preserving natural gut microbiota and reducing C. diff proliferation. In healthcare settings, strict environmental cleaning and disinfection protocols are essential, using disinfectants effective against C. diff spores, like bleach-based cleaners, on high-touch surfaces. Isolation precautions, including gowns and gloves for healthcare professionals, are implemented for infected patients to prevent transmission.