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C. diff Epidemic: What You Must Know

Why C. diff Is Spreading, Why It's More Deadly, How to Protect Your Family

Who is at risk?

More than nine out of 10 hospital infections with C. diff occur in people who have received antibiotic treatment.

But community-acquired C. diff does not depend on antibiotics. The CDC's McDonald says there's evidence that 30% to 40% of community-acquired cases are in people not suffering a current or recent medical problem.

Fluoroquinolone antibiotics are most strongly linked to C. diff disease. Risk is also higher for patients who receive multiple antibiotics and for patients who receive longer courses of antibiotic treatment.

Other risk factors include:

  • Age over 65
  • Severe illness
  • Nasogastric intubation
  • Anti-ulcer medications. There is conflicting evidence on this.
  • Long hospital stays, particularly in long-term-care facilities

It's not at all clear how long it takes to get C. diff disease after you've ingested the spores. One study that performed a series of cultures in hospital patients showed that patients who had C. diff disease were not infected the week before.

This suggests incubation can occur in less than seven days. But another study found an increased risk of C. diff disease throughout the first four weeks after leaving the hospital.

What are the symptoms of C. diff disease?

Mild C. diff disease starts with mild to moderate diarrhea with no blood in the stool. Sometimes there's cramping in the lower abdomen, too. Other than mild abdominal tenderness, there aren't any other symptoms.

Severe C. diff disease is another matter. It starts with profuse watery diarrhea and abdominal pain. Patients often have fever, nausea, and dehydration. There may be a little blood in the stool, but very bloody stool is rare.

These symptoms usually signal colitis, a serious bowel infection. If the diarrhea stops after severe colitis, it does not necessarily mean you're getting better. It could be a sign of bowl paralysis and a life-threatening condition called toxic megacolon. Most patients with toxic megacolon need surgery -- and 32% to 50% of patients who undergo surgery for C. diff disease die.

Patients with symptoms of C. diff infection should seek immediate medical attention. Mild C. diff disease can progress quickly to severe disease.

Relapse is common after C. diff infection. There's an ongoing debate over whether this is a true relapse or reinfection.

Whatever the cause, 12% to 24% of patients develop a second episode of C. diff disease within two months. Patients who have two or more relapses have a 50% to 65% chance of yet another recurrence.

How is C. diff treated?

Several different stool tests detect C. diff.

Before starting treatment, stopping treatment with whatever antibiotic you've been taking could be enough. Before effective treatments were developed, one study of 20 patients with C. diff colitis eventually recovered after stopping their antibiotic treatment.

However, doctors will almost always treat C. diff infection with antibiotics. Flagyl is the first-line treatment of choice for mild disease, although patients must be followed closely to be sure this treatment works. Vancomycin is an option for treatment for moderate or severe disease.

There is evidence that treatment with probiotics -- good bacteria that repopulate the gut -- makes antibiotic treatment more effective and prevents relapse. Saccharomyces boulardii appears to be particularly effective, although good results have been seen with Lactobacillus species as well.

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