All About C. Diff

October 8th, 2012  |  The Blog

What is C. diff? This is a dangerous bacterium, formally called Clostridium difficile, which causes diarrhea in the infected patient. Most often, this illness occurs after taking a course of antibiotics.

Clostridium difficile is found in many areas of the environment, air, water, soil and feces, both human and that of animals. The bacterium is excreted through feces and spread to food and inanimate objects by a carrier who does not thoroughly wash their hands after using the bathroom. The bacteria lives in the form of spores, which can live on surfaces for weeks or months.

Who Gets C. diff?

About 500,000 patients contract C. diff annually in the U.S. Most of the infected patients are in the hospital or reside in a skilled nursing facility or nursing home when they are diagnosed. There are cases of C. diff in patients who have neither been in the hospital nor been taking antibiotics.

Patients taking broad-spectrum antibiotics for other health issues are at risk for developing C. diff. While the broad-spectrum antibiotic kills the germs for which it is intended, it also kills the “good” bacteria in the intestines. This sets the stage for C. diff to overgrow in the intestines. The most common antibiotics that lead to C. diff are penicillins, cephalosporins and fluoroquinolones.

Age is a risk factor. Being over 65 years old contributes to the risk of developing C. diff.

C. diff can be a recurring problem. Patients who have previously had the illness are more likely to contract it again. Three or four previous cases of the illness set a patient up for a better than 50 percent risk of future recurrence.

Current Treatment Plan

Some patients do not exhibit any symptoms of C. diff but can still transmit the illness to others. The acute symptom of C. diff is diarrhea. The acuity of the diarrhea ranges from mild to severe, resulting in potentially life-threatening colitis. Colitis is a major inflammation of the intestines, which can lead to ulceration. Symptoms can develop while taking an antibiotic, shortly after finishing the course or even weeks or months later.

Mild symptoms:

  • Watery diarrhea three or more times a day for more than two days
  • Abdominal cramping

Severe symptoms:

  • Watery diarrhea ten to fifteen times a day
  • Fever
  • Blood or purulent material mixed with stool
  • Dehydration
  • Nausea and loss of appetite

The common medical treatment for C. Diff is a course of Flagyl (metronidazole) and/or Vancocin (vancomycin). The treatment is initially effective 80-90% of the time. Research show that symptoms do recur in 25% of affected patients after initially successful treatment. So, how do we improve the treatment and outcome?

New Treatment

There is a new antibiotic on the horizon to treat C. diff. Cadazolid is in the initial stages of evaluation. The initial guidelines recommend twice a day dosing for ten days. Research continues on the drug to determine the ultimately correct dose to effectively treat C. diff., with regard to symptom relief and the rate of recurrence.

The most common side effect of the drug is headache. Otherwise, it is well tolerated.

Prevention

There are some guidelines to follow to prevent reinfection for the patient and the spread of the infection to others:

  • Hand washing is critical with soap, water and friction, not alcohol-based hand sanitizers.
  • Contact precautions must be followed in a hospital setting. All staff members who come in contact with an infected patient must wear disposable gowns and gloves.
  • Clean all surfaces with chlorine bleach. It is the only cleaning product that will kill the C. diff spores.
  • Avoid taking antibiotics in the future unless absolutely necessary.

Outcome

With the current treatment regime and according to a recent Dutch study, patients infected with C. diff have twice the risk of dying than those who do not have the infection.

The ultimate goal of endorsing and approving a new drug to treat C. diff is to find one that will destroy the bad bacteria while preserving the necessary “good” bacteria.

 

 

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