Clostridium Difficile (C. Diff) Infection

The stomach and intestines have hundreds of kinds of bacteria. Many of these bacteria actually help keep harmful bacteria, such as C. diff, from causing problems. Small amounts of C. diff are normal in the intestine and don’t cause problems. When you take an antibiotic, the normal balance of good and bad bacteria may be affected. There may be too few of the good bacteria. This may allow the harmful bacteria, such as C diff, to grow. In hospitals and nursing homes, C. diff may be spread from an infected person to others. This can happen when staff or visitors touch infected people or objects (such as bed rails, stethoscopes, or bedpans) and then touch other people or surfaces.

Sometimes people carry the C.diff germs but do not get sick. This is called colonization. Colonization is more common that C.diff infection and does not need treatment. But they can still pass the infection to others. Others do have symptoms. Mild symptoms include:

• Watery diarrhea, ( 3 or more times a day for several days)

• Stomach pain, tenderness, and cramping

Some people who are infected develop more severe symptoms. Symptoms include:

• Severe stomach pain or tenderness

• Frequent watery diarrhea (up to 15 times a day)

• Belly swelling

• Upset stomach (nausea) and vomiting

• Loss of appetite
• Blood or pus in the stool
• Fever

To confirm the infection, a stool sample is taken. It's tested for the bacteria or the toxins made by the bacteria.

In many cases, you will be given an antibiotic or other medicine or therapy directed at the C. diff infection. Your healthcare provider might advise that you stop taking or change the antibiotics you've been prescribed. Talk with your provider before stopping or starting any medicines.

• Fluids are often given by IV (intravenously) through a vein. This helps replace fluids lost through diarrhea.

• In rare cases, you may need surgery if treatment doesn’t cure severe symptoms.

To reduce symptoms:

• Drink plenty of fluids to replace water lost through diarrhea. Talk with your healthcare provider or nurse about which fluids are best.

• Follow your provider’s instructions for when and what to eat.

• Unless your provider tells you to do so, don't take medicines for diarrhea.

• Tell your provider if symptoms return. Even after treatment, C. diff may come back.

Your healthcare provider may give you an additional treatment if your symptoms come back. Or if you're not able to clear the C. diff infection with a standard course of treatment. This could include:

• A longer, decreasing course (called a taper) of treatment with the antibiotic vancomycin and metronidazole.
• A procedure (fecal transplant) in which normal fecal material is put into your intestines. This is done to give you the good bacteria again and stop the C diff infection from coming back.
• A medicine called bezlotoxumab. In some cases, it can help prevent your symptoms from returning.

Complications include:

• Fluid loss (dehydration)

• Electrolyte imbalances

• Low protein in the blood

• Severe widening (dilation) and inflammation of the large intestine (toxic megacolon)

• A hole (perforation) in the bowel (often caused by toxic megacolon)

• Low blood pressure

• Kidney failure

• Inflammation or infection all over the body

• Death

Hospitals and nursing homes take these steps to help prevent C. diff infections:

• Limiting use of antibiotics. Giving antibiotics only when needed can help reduce C. diff infections.

• Handwashing. Hospital staff should wash their hands before and after treating each person. They should also wash their hands after touching any surface in someone's room. Washing hands with soap and clean, running water for at least 20 seconds works better than alcohol-based hand cleaners for C. diff.

• Protective clothing. Healthcare workers should wear gloves and a gown when entering the room of someone with C. diff infection. They should remove these items before leaving and then wash their hands.

• Private rooms. People with C. diff should be in private rooms to prevent the spread of infection.

• Thorough cleaning. Equipment and rooms should be cleaned and disinfected every day and deep-cleaned between each new person staying there.

• Education. Everyone should be shown the best ways to prevent infection.

You can do the following to help prevent C. diff:

• Take antibiotics only when you really need them. Antibiotics don’t help treat illnesses caused by viruses. This includes colds and the flu. Don’t ask for antibiotics from your healthcare provider if they say they won’t work.

• When you're given antibiotics, take them as directed. Don’t take more or less than the dosage prescribed. Unless otherwise instructed, finish the entire prescription even if you feel better.

• Wash your hands carefully. Do this after using the bathroom and before eating. Use plenty of soap and clean, running water. And wash for at least 20 seconds. Alcohol-based hand cleaners may not work against C. diff germs.

• Teach children correct handwashing. Show them good handwashing methods in all situations.