The average human digestive tract is home to as many as 1,000 species of microorganisms. Most of them are harmless -- or even helpful -- under normal circumstances. But when something upsets the balance of these organisms in your gut, otherwise harmless bacteria can grow out of control and make you sick. One of the worst offenders is a bacterium called Clostridium difficile(C. difficile, or C. diff). As the bacteria overgrow they release toxins that attack the lining of the intestines, causing a condition called Clostridium difficilecolitis.
Though relatively rare compared to other intestinal bacteria, C. diff is one of the most important causes of infectious diarrhea in the U.S.
Symptoms of C. diff
Symptoms of more severe C. diff infection include:
- Watery diarrhea, up to 15 times each day
- Severe abdominal pain
- Loss of appetite
- Blood or pus in the stool
- Weight loss
In some cases, C. diff infection can lead to a hole in the intestines, which can be fatal if not treated immediately.
C. diff can be diagnosed by stool specimens tested for the toxins. In some cases, a colonoscopy may be needed for diagnosis and more tests ordered.
Risk Factors for C. diff
Although C. diff occasionally causes problems in healthy people, it is most likely to affect patients in hospitals or long-term care facilities. Most have conditions that require long-term treatment with antibiotics, which kill off other intestinal bacteria that keep C. diff in check. While use of any antibiotic can potentially lead to C. diff overgrowth, it most commonly occurs with the use of an antibiotic that is broad-spectrum, or able to kill a wide variety of bacteria. It also happens more often when multiple antibiotics are needed to fight infection and when the antibiotics need to be taken for a long period of time.
Other risk factors for C. diff infection include:
- Surgery of the gastrointestinal (GI) tract
- Diseases of the colon such as inflammatory bowel disease or colorectal cancer
- A weakened immune system
- Use of chemotherapy drugs
- Previous C. diff infection
- Advanced age -- 65 or older
- Kidney disease
- Use of drugs called proton-pump inhibitors, which lessen stomach acid
Treatments for C. diff
Doctors typically prescribe a 10- to 14-day course of one of the following oral antibiotics: metronidazole (Flagyl), Dificid (fidaxomicin), or vancomycin (Vancocin). Flagyl is usually tried first. Improvement usually happens within 72 hours after starting antibiotics, but the diarrhea may return temporarily. Another round of antibiotics is needed in about 25% of cases.
In addition to prescribed medications, treatment may include:
- Probiotics. Available in most drug and health food stores without a prescription, probiotics are "good" bacteria that colonize in the gut. They may help keep C. diff. infection from recurring if taken along with prescribed medicines. But more research is needed to see if this can help.
- Fluids. Drinking plenty of water and other fluids or getting intravenous fluids can help guard against dehydration from diarrhea.
Other treatments that are being studied for severe C. diff infections include fecal transplants and treatment with monoclonal antibodies.
If you think you may have a C. diff infection, speak to your doctor before using an anti-diarrhea medicine. Stopping the diarrhea could actually make the C. diff infection worse.
Preventing C. diff Infection
Once a person has C. diff infection, the infection can spread to others. C. diff spores are shed in the feces and can live on dry surfaces for a long time. A person who touches one of those surfaces can pick up the infection.
Fortunately, infection can be prevented. If you are visiting a health care facility or are in contact with someone who has the infection, good hygiene is vital. The following precautions can help keep you -- and others -- safe:
- Wash your hands with soap and water frequently. Do not rely just on alcohol-based hand sanitizers.
- Clean surfaces in bathrooms and kitchens regularly with chlorine bleach-based products.
- Wash soiled clothing with detergent and chlorine bleach.
- If you are visiting someone in a health care facility, wash your hands before and after your visit. If you use the restroom, wash your hands well to remove possible C. diff spores.
- Don't use antibiotics unless your doctor recommends them.