Clostridioides difficile, commonly known as C. diff, is a bacterium that can cause severe diarrhea and inflammation of the colon. This bacterium is a significant health concern, particularly in healthcare settings and among individuals who have recently taken antibiotics. C. diff is challenging to eliminate because it forms hardy, dormant spores that survive harsh conditions and persist in the environment.
Treating C. difficile Infection
Medical strategies to eliminate C. difficile from the body involve specific antibiotic treatments and, for recurrent cases, fecal microbiota transplantation. When a C. difficile infection develops while a patient is already on antibiotics for another condition, the first step often involves discontinuing the inciting antibiotic, if medically appropriate. Stopping the original antibiotic may allow the gut’s natural bacterial balance to recover and suppress the C. difficile overgrowth.
If symptoms persist or the infection is more severe, specific antibiotics are prescribed to target C. difficile. Fidaxomicin and vancomycin are the primary antibiotics used for treating C. difficile infection. These antibiotics work by directly inhibiting the growth of C. difficile bacteria in the gut.
For cases of recurrent C. difficile infection, especially after multiple antibiotic treatments have failed, Fecal Microbiota Transplantation (FMT) has become a highly effective option. FMT involves introducing stool from a healthy donor into the patient’s colon to restore a balanced and diverse gut microbiome. This process helps to re-establish healthy intestinal bacteria, which can outcompete C. difficile and prevent future recurrences. Additionally, a human antibody therapy called bezlotoxumab may be considered for patients at high risk of recurrent C. difficile infection.
Disinfecting Contaminated Environments
Eliminating C. difficile spores from environmental surfaces is a crucial aspect of infection control. These spores are highly resistant to many common cleaning agents and can endure in the environment for months. Alcohol-based hand sanitizers are ineffective against these resilient spores.
Effective disinfection requires specific sporicidal agents. Bleach-based products, such as sodium hypochlorite, and hydrogen peroxide-based disinfectants are recommended for inactivating C. difficile spores on surfaces. A common and effective dilution for household bleach is a 1:10 ratio of bleach to water, which should be prepared daily to maintain its potency. These solutions work by oxidizing the spores, breaking down their protective structure.
When disinfecting, first clean the area with a detergent to remove visible dirt and organic matter before applying the disinfectant. High-touch surfaces, such as doorknobs, light switches, bedrails, and toilet areas, require particular attention. For laundry potentially contaminated with C. difficile, washing items in the hottest water safe for the fabric (e.g., 160 degrees Fahrenheit for 25 minutes) and using chlorine bleach, if suitable, can effectively kill spores.
Strategies to Prevent Spread and Recurrence
Preventing the spread of C. difficile and minimizing recurrence involves a multi-faceted approach, focusing on meticulous hygiene and responsible antibiotic use. Hand hygiene is paramount, with soap and water being superior to alcohol-based hand sanitizers for removing C. difficile spores. The physical action of washing with soap and water effectively removes the spores from the hands.
In healthcare settings, isolation precautions are implemented for patients with suspected or confirmed C. difficile infection. This typically involves placing affected individuals in private rooms, using dedicated patient care equipment, and requiring healthcare personnel and visitors to wear disposable gowns and gloves upon entering the room. These precautions are often continued for at least 48 hours after diarrhea resolves.
Antibiotic stewardship plays a central role in preventing C. difficile infections by promoting the appropriate use of antibiotics. This includes avoiding unnecessary antibiotic prescriptions, choosing the narrowest spectrum antibiotic when possible, and ensuring the shortest effective duration of treatment. Avoiding future broad-spectrum antibiotic use when possible and consuming adequate fluids to prevent dehydration are important steps to reduce the risk of recurrence.