Clostridium difficile: Why it causes such a stir

Clostridium difficile (usually called C. difficile) outbreaks make the headlines every once in a while. But what’s so special about these bacteria that they would draw so much media attention and alarm medical personnel?

What is C. difficile? C. difficile bacteria cause symptoms ranging from simple diarrhea to a severe inflammation of the colon. No-one is immune to these bacteria, but they most commonly strike hospitalized individuals and the elderly living in long-term care facilities. The infection usually appears during or soon after an antibiotic treatment, but it could also strike weeks or even months later.

The main symptoms include profuse diarrhea lasting for at least two days, along with cramps and abdominal tension. The signs of a severe infection include:
- Diarrhea
- Abdominal cramps and pain
- Fever
- Blood or pus in the stools
- Nausea
- Dehydration
- Loss of appetite
- Weight loss

Complications Possible complications of C. difficile include:

- Dehydration and renal failure caused by diarrhea. Since the body is made up mainly of water, the significant loss of fluids and electrolytes caused by diarrhea can affect the work of certain organs and lead to a dangerous drop in blood pressure.

- If the bowel cells are seriously damaged, a perforation can occur. In such cases, the risk is that bacteria from the colon might spread to the abdominal cavity and cause a very severe infection.

- When the colon becomes extremely distended due to the fact that it can’t expel stools and gas, a syndrome called toxic megacolon can develop. If this goes unaddressed, the colon can rupture, which requires emergency surgery.

- Death can occur if the infection is not stopped in time.

How the infection is transmitted C. difficile bacteria are naturally occurring in the environment. Some healthy individuals even carry them in their colon. The intestines normally contain millions of “good” bacteria that contribute to digestion and help protect the body. When we take antibiotics to cure an infection, the medication attacks the specific bacterium that caused the infection, but also some of our helpful bacteria. When these good bacteria become too depleted, C. difficile can quickly take over.

C. difficile infections are more common in hospitals and other healthcare facilities where antibiotic treatments are common and the proportion of individuals carrying the bacterium is higher. The infection is transmitted when bacteria from feces contaminate foods, surfaces or objects if infected individuals have not washed their hands thoroughly.

The problem is that C. difficile has a shell that protects it from the elements, so it can survive weeks or even months in a room. It can be transmitted by shaking someone’s hand, but also by touching a doorknob, bed, nightstand, sink, stethoscope, thermometer, phone or electronic controls.

Why is C. difficile so dangerous? C. difficile is problematic because it can survive a long time in the environment and strikes individuals whose health is already vulnerable. Healthy individuals have a lower risk of developing a C. difficile infection.

In addition, new C. difficile bacterial strains have emerged in the past few years, and they produce even more toxins, which increases the severity of the infection.

Diagnosis This infection is diagnosed based on clinical symptoms, but it is usually confirmed through a lab test and sometimes a colonoscopy as well, so that the inflammation and state of the colon can be examined directly.

Treatment Whenever possible, the first phase involves stopping the use of the antibiotic that caused the original infection. In mild cases, this may be enough to improve the situation, but in many cases it isn’t.

Treating the diarrhea involves taking liquids containing water, salts and sugars, such as the rehydration solutions sold in drugstores, sports drinks, or diluted fruit juices to which salt is added. If the patient is hungry enough, acceptable foods include potatoes, pasta, rice, bread and oatmeal. Salted crackers, bananas and soups are also appropriate.

Ironically, the usual treatment for these infections is to take an antibiotic. The medication stops C. difficile from growing and allows helpful bacteria to return to their proper place in the intestines.

In severe cases, surgery may prove necessary in order to remove the affected section of the colon.

Preventing C. difficile The best way to prevent an infection is to observe strict hygiene measures to stop C. difficile from spreading among patients at a healthcare centre, and being transmitted from patients to their visitors and healthcare professionals.

- Hand washing is absolutely essential. Individuals visiting or caring for patients must wash their hands before and after their visit. Preferably use warm water and soap, as this appears to be more effective than alcohol gels at killing C. difficile bacteria.

- When cleaning a room and objects having been in contact with an infected individual, use products that contain bleach (chlorine). C. difficile can survive regular cleaning products that do not contain bleach.

- Use antibiotics only when truly necessary. Antibiotics can save the life of individuals suffering from a bacterial infection, but they are useless against viral infections like colds or the flu. If you need to take antibiotics, make sure to respect the directions you receive from your doctor and pharmacist.

When to see a doctor Loose stools are a common adverse effect of taking an antibiotic, but this does not mean you have a C. difficile infection.

You should see your doctor if you have watery stools that last for more than three days or if you have a new bout of fever, significant pain, cramps, blood in your stools, or more than three watery bowel movements per day.