Clostridioides difficile, often called C. diff, is a bacterium that causes intestinal infections ranging from diarrhea to life-threatening inflammation of the colon. While many associate C. diff with hospital stays, cases are increasingly appearing in the general population. This is known as community-acquired C. diff and is changing the understanding of who is at risk.
Defining Community-Acquired C. diff
An infection is classified as community-acquired if it is diagnosed in someone who has not been a patient in a hospital or long-term care facility within the last 12 weeks. This diagnosis also applies if symptoms begin within the first 48 hours of a hospital admission, suggesting the infection was contracted beforehand.
This contrasts with healthcare-associated infections, where high-risk patients were older adults with recent hospitalizations or in nursing homes. Community-acquired cases are changing this perception, as they are increasingly found in younger, healthier people. This rising incidence outside of medical facilities indicates a broader public health concern.
The bacterium is transmitted through the fecal-oral route. An infected person sheds a large number of spores in their feces, which can contaminate their skin and surrounding surfaces. These hardy spores can survive for weeks or months in the environment and resist many common cleaning agents.
Risk Factors and Transmission
The most significant risk factor for a C. diff infection is recent antibiotic use. These medications disrupt the balance of beneficial bacteria in the gut, allowing C. diff to multiply and produce toxins that damage the intestinal lining. While many antibiotics can trigger an infection, some are more commonly associated with it.
Other factors also increase susceptibility. Medications that reduce stomach acid, such as proton pump inhibitors (PPIs), have been linked to a higher risk. Advanced age (over 65) and compromised immune systems from chronic conditions or treatments like chemotherapy also make individuals more vulnerable.
C. diff transmission occurs when a person ingests its spores. These microscopic spores are passed through feces and can settle on surfaces like bathroom fixtures, doorknobs, and electronics. Touching a contaminated surface and then the mouth can introduce the spores into the body.
Symptoms and Diagnosis
The most common sign of a C. diff infection is watery diarrhea, occurring multiple times a day. Other symptoms include abdominal cramping and pain, fever, loss of appetite, and nausea. In some cases, individuals may experience more than 20 bowel movements in a single day.
Certain symptoms signal a more severe infection requiring immediate medical evaluation. The presence of blood in the stool, significant dehydration, or intense abdominal pain are reasons to seek help from a healthcare provider. These could indicate a serious complication, such as severe inflammation of the colon (pseudomembranous colitis).
To diagnose the infection, a healthcare provider will review the patient’s medical history, noting any recent antibiotic use. A definitive diagnosis requires a stool sample to be tested in a laboratory. The sample is analyzed for toxins produced by the C. diff bacteria, which confirms an active infection.
Treatment and Prevention
The first step in treating a C. diff infection is to discontinue the antibiotic that triggered it, if possible. The infection is then treated with a specific course of antibiotics, such as vancomycin or fidaxomicin, which are taken for about 10 days.
For patients with recurrent or severe infections, more advanced treatments are available. One option is a fecal microbiota transplantation (FMT). This procedure transfers stool from a healthy donor into the patient’s colon to restore the natural balance of gut bacteria and suppress C. diff growth.
Preventing community-acquired C. diff involves several actions. Antibiotics should only be taken when necessary and as prescribed. Because C. diff spores are resistant to alcohol-based hand sanitizers, thorough handwashing with soap and water is necessary to physically remove them. This is especially important after using the restroom and before handling food.
When cleaning potentially contaminated surfaces, use appropriate products. C. diff spores resist many standard household cleaners. Bleach-based products are most effective at killing the spores and should be used to disinfect bathrooms and high-touch surfaces, especially if a household member is ill.