This is an overview of infection with the Clostridium difficile bacterium,
commonly referred to as C. difficile, or simply C. diff.
The human digestive tract is home to an estimated 500 to 1,000 different species of microorganisms,
most of which are harmless, or even helpful, and live in harmony.
But if something upsets the balance of these bacteria, such as treatment with antibiotics or cancer
chemotherapy, certain harmful organisms can multiply out of control and cause illness.
Clostridium difficile infection, or CDI for short, is an example of this.
CDI is a bacterial infection that causes diarrhea – which can sometimes be debilitating – and
other intestinal symptoms, by inflaming the colon, causing something known as colitis.
When the gut’s beneficial bowel bacteria are disrupted, the C. diff bacterium can multiply,
producing toxins that damage the bowel and cause intestinal symptoms.
In very severe cases, C. diff infection can even result in death.
A person might harbour the C. diff bacteria in their gut but do not become sick, because
the beneficial bacteria in their intestine keep it in check.
However, there are a few risk factors that, when present, might to varying degrees, increase
the chance of contracting C. diff infection.
These include: being older than 65 years of age,
taking antibiotics, especially over a prolonged period of time,
having a severe underlying illness, being in an immune-compromised state,
receiving chemotherapy to treat cancer, taking proton pump inhibitors
to reduce stomach acid, having had a previous episode of CDI,
having a prolonged hospital or care home stay,
because there you have an increased risk of being exposed to the bacterium.
A recurrent case of CDI can be defined as a return of symptoms, with lab confirmation
of C. diff infection, after successful treatment the first time.
Most recurrences occur within 1-8 weeks.
In other words, recurrence means experiencing more than one episode even after the previous
episode has been cured.
This a major challenge, as recurrent CDI can cause a large burden of disease to patients and society.
Unfortunately, C. diff is a resourceful bacterium.
It forms spores that are resistant to antibiotics and to many alcohol-based cleaning agents,
which allows the bacterium and its spores to last on surfaces for months.
Each episode of CDI increases the likelihood of a subsequent episode.
Many patients can experience multiple occurrences over the course of their stay in a health
care facility or have to return repeatedly to a hospital for treatment because it recurs.
Approximately 1 in 4 patients who experience one episode of C. diff will have a recurrence.
Of this group, about 45% will experience another episode, and of those patients, 60% will experience
further bouts of the infection.
CDI is the most common cause of infectious diarrhea in hospitals and long term care facilities.
In fact, patients often develop the infection after going to the hospital or other health
care setting to receive treatment for another ailment.
This is because the C. diff bacterium and its spores are found in high amounts in feces
of infected people, who can then spread the infection to surfaces, such as food or other
objects, especially if they don’t wash their hands properly after using the toilet, and if proper
cleaning protocols are not in place in healthcare facilities.
A person might not have any symptoms and still be able to spread C. diff bacteria.
Others could become infected if they touch these contaminated surfaces, then do not wash
their hands thoroughly, and subsequently ingest the bacteria or spores.
Despite the efforts hospitals go through to combat C. diff, many are still experiencing
outbreaks.
Some hospitals have incorporated novel technology to help clean rooms, such as using ultraviolet lights
that kill bacteria left after conventional cleaning, while others have greatly enhanced
infection control measures that include diligent hand washing programs.
However, effective treatment for C. diff remains an important element in managing the challenges
associated with these infections in the hospital.
The most important aspect of the infection is the profound impact it has on a patient’s
quality of life.
In addition to the painful physical effects and lifestyle consequences, C. diff might
also have a significant emotional impact.
It can be as uncomfortable to discuss as it is to manage.
The most commonly used treatments for C. diff are antibiotics.
Since C. diff is intrinsically resistant to many types of antibiotics, which is why it survives
when antibiotics kill other bacteria,
researchers have been looking for more effective treatments.
Studies looking at therapies to address the role of the immune system
in treating or preventing C. diff infection are underway.
One promising option, when other treatments fail, is fecal transplantation,
which works by fixing the balance of microorganisms in the gut, by introducing
bacteria from a non-infected person's gut.
If you or someone you know is suffering from Clostridium difficile infection, there are
resources available to help ease the situation.
Speak to your health care provider about available treatments, including those that are newer,
and address the issue of recurrence,
so that you can find optimal care.
I’m Dr. James Gray on behalf of the Gastrointestinal Society.
Thanks for watching.