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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

How do you get C. diff? continued...

C. diff bacteria are very sensitive to oxygen. But C. diff spores are another matter. They are nearly indestructible and can survive for months on dry surfaces. The CDC recommends disinfecting surfaces with bleach, because the usual hospital disinfectants don't affect it.

People with C. diff infection have millions of C. diff spores in their feces. These spores carry the infection to others via what experts indelicately call fecal-oral contact. Careful hand washing rinses the spores from contaminated hands, but alcohol gels won't do the trick.

Two things have to happen for you to get C. diff disease:

  • You have to ingest C. diff spores.
  • Something has to disturb the ecological balance of the normal bacteria living in your colon.

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.

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