Bacterial Infection Caused by Clostridium Difficile Symptoms, Causes & Treatment Options

If you ask any healthcare professional about bacterial infection caused by Clostridium difficile (often referred to as C. diff), they will inevitably start talking about poop. Clostridium difficile is the leading cause of hospital-acquired diarrhea in the United States and a serious bacterial pathogen.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Bacterial Infection Caused By Clostridium difficile?

Summary

Clostridium difficile is an interesting bacterial pathogen. It is pervasive in nature and very prevalent in the soil. In addition, the bacteria form spores that can survive very harsh environments. C. difficile spores are resistant to high temperatures, ultraviolet light, harsh chemicals, and even antibiotics [1].

C. diff has a propensity for infecting the gastrointestinal tract, and it releases toxins that cause the symptoms and complications related to the infection — most significantly diarrhea.

Though Clostridium difficile can be found on many surfaces, it is transmitted from person to person via the fecal-oral route (a person touches infected feces, touches his/her face or mouth and the bacteria infects a new gastrointestinal tract. Though this may sound very gross and unlikely, this infection route is very common, especially in hospitals.

Hospitals have a surplus of patients shedding C. diff spores into their feces and surrounding environments. Multiple hospital personnel encounters these patients, and because C. diff is so resistant, even with the best disinfectants and hygienic precautions, C. diff spores can be transmitted to hands, utensils, and foods and easily swallowed by someone else.

Recommended care

Bacterial Infection Caused By Clostridium difficile Symptoms

Main symptoms

The main symptoms of bacterial infection caused by Clostridium difficile are gastrointestinal in nature. These symptoms can vary from person-to-person in severity and duration, but most people with C. diff infection experience the symptoms below:

  • Diarrhea: including loose, watery stools (poop) or frequent bowel movements for several days
  • Fever
  • Stomach tenderness or pain
  • Loss of appetite
  • Nausea

Risk factors for infection

In most healthy individuals, if Clostridium difficile gets to the gastrointestinal tract, the gut microflora can stop toxin release and further infection. The gut microflora is the good bacteria in our abdomen that help us stay healthy. These bacteria produce vitamin K, stimulate the immune system, and detoxify various chemicals that might otherwise be harmful [2].

People at risk of getting a bacterial infection caused by Clostridium difficile have gut microflora that has been injured or damaged. The following medications/situations are known to affect the gut microflora and most often put people at risk:

  • Antibiotics
  • Proton pump inhibitors
  • Serious illnesses (autoimmune)
  • Prolonged hospitalizations
  • Anti-ulcer medications
  • Older age (65+ years)

Bacterial Infection Caused By Clostridium difficile Causes

As mentioned above, infection by Clostridium difficile is caused by ingestion of the bacteria from spore-ridden feces. Individuals with healthy gut microflora often clear or suppress the bacteria; however, in unhealthy individuals who cannot, Clostridium difficile releases toxins that injure the lining of the intestines and produce diarrhea and inflammation. In C. diff infection, the toxins are the factors that cause disease.

Clostridium difficile is extremely contagious, so it is important to know and understand how to prevent disease.

Medications

The following medications are notorious for causing transient damage/injury to the gut microflora.

  • Antibiotics: According to Harvard Health, almost any antibiotic can predispose for C. diff, but the most frequent offenders are drugs such as clindamycin and broad-spectrum penicillins, cephalosporins, and fluoroquinolones.

  • Acid-modifying medications: Acids are very important in fighting off C. diff. For example, medications such as proton pump inhibitors, which decrease stomach acid, increase the risk of symptomatic C. difficile infection.

Immunosuppression

Immunosuppression refers to the suppression of the body’s immune system and its ability to fight infections. Many conditions can put the body in an immunosuppressive state including:

  • Illnesses/certain diseases: Autoimmune diseases (those that directly attack the immune system) directly are obvious culprits; however, even illnesses that are not autoimmune and are simply prolonged can also cause immunosuppression.

  • Medications: Sometimes patients need to be purposely given medications that suppress their immune system for situations such as transplants.

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Treatment Options, Relief, and Prevention for Bacterial Infection Caused By Clostridium difficile

Treatment

Treatment for bacterial infection caused by Clostridium difficile often requires a three-pronged approach:

  • Step 1: Stop the offending antibiotic or medication. Without this step, there is no point in continuing steps 2 and 3. In some cases, it is easy to identify the offending antibiotic, but in other situations, patients may be on multiple antibiotics.

  • Step 2: Treat with an antibiotic that will kill the C. diff. The antibiotics that kill C. diff include vancomycin by mouth and metronidazole (Flagyl) through an IV (intravenous line).

  • Step 3: Give the body bacteria that can help suppress future C. diff. Probiotics are harmless microbes that patients can take to help restore their gut microflora. According to Harvard Health, these probiotics may reduce the risk of developing a serious infection, but there is insufficient evidence that they can help with recovery [2].

  • Fecal transplant: For patients with recurring Clostridium difficile infection, this new and interesting treatment option is currently available. Fecal microbiota transplantation (FMT), also known as stool transplantation, is a procedure in which stool from a healthy donor is placed into the gut of a patient to treat a certain disease [3].

Prevention

As mentioned, Clostridium difficile is extremely hardy and resistant to many preventative measures such as alcohol-based disinfectants and cleaning agents. However, that does not mean proper hygienic measures are a lost cause!

In healthcare settings, patients with C. diff should be quickly identified and separated from other patients in isolated rooms. All people in contact with these patients should wear protective gear including gloves and gowns, and wash their hands with soap and water after exposure.

Even at home, people should wash hands with soap and make sure to scrub thoroughly if they think they have had contact with someone with Clostridium difficile. People with diarrhea should also self-isolate by taking preventative measures such as using their own utensils and not cooking food for others.

When to Seek Further Consultation for Bacterial Infection Caused By Clostridium difficile

If you are experiencing symptoms of diarrhea especially after taking antibiotics, be very suspicious about possible bacterial infection by Clostridium difficile. See a healthcare provider as soon as possible.

References

  1. Heinlen L, Ballard JD. Clostridium difficile infection. Am J Med Sci. 2010;340(3):247–252. NCBI Link

  2. Clostridium difficile: An intestinal infection on the rise. Harvard Health Publishing: Harvard Health Men’s Watch. Updated July 13, 2018. Harvard Health Publishing

  3. Allegretti J. Stool transplants are now standard of care for recurrent C. difficile infections. Harvard Health Publishing. Updated June 3, 2019. Harvard Health Link