Clostridium difficile
Definition:

C. difficile bacteria are everywhere — in soil, air, water, human and animal feces, and on most surfaces. The bacteria don’t create problems until they grow in abnormally large numbers in the intestinal tract of people taking antibiotics or other antimicrobial drugs.

Symptoms:
Some people who are infected with C. difficile never become sick, though they can still spread the infection. Others have bouts of watery diarrhea, often with nausea and abdominal pain and cramping. And an increasing number of people develop colitis or pseudomembranous colitis — severe inflammations of the colon. Signs and symptoms of these potentially life-threatening illnesses include:
 Profuse, watery diarrhea — 10 or more bowel movements a day
 Fever, often greater than 101 F
 Abdominal pain, which may be severe
 Blood or pus in the stool
 Nausea
 Dehydration
 Weight loss
Most people develop C. difficile infection during or shortly after a course of antibiotics, but signs and symptoms may not appear for weeks or even months after treatment has stopped.
Causes:
Your intestinal tract contains hundreds of kinds of bacteria (intestinal flora). Many are essential, helping to synthesize certain vitamins and stimulating the immune system. And some play a key role in suppressing the growth of harmful organisms. But when you take an antibiotic to treat an infection, it often destroys these beneficial bacteria as well as the bacteria that’s causing your illness. Without enough healthy bacteria, dangerous pathogens such as C. difficile can quickly grow out of control.
Once it takes hold, C. difficile can produce two virulent toxins that attack the lining of the intestine. The toxins destroy cells and produce pseudomembranes — telltale patches (plaques) of inflammatory cells and decaying cellular debris on the interior surface of the colon.
Almost any antibiotic can cause harmful bacteria to proliferate in the intestine, but ampicillin, amoxicillin, clindamycin, fluoroquinolones and cephalosporins are most often implicated in C. difficile infections. The use of broad-spectrum drugs that target a wide range of bacteria and the taking of antibiotics for a prolonged period increase the chance of infection. Other antimicrobials, including antiviral and antifungal drugs, and chemotherapy medications also can lead to an increased risk of infection with C. difficile
How C. difficile spreads

Although a small number of people naturally have C. difficile in their intestinal tract, most people pick up C. difficile from the environment. The bacteria are eliminated in feces and spread to food, surfaces and objects when people who are infected don’t wash their hands thoroughly. Although you can develop a C. difficile infection anywhere, the majority of cases occur in healthcare settings, where germs spread easily, antibiotics are common and people are especially vulnerable to infection.
In hospitals and nursing homes, C. difficile travels from patient to patient mainly on the hands of caregivers, but also on cart handles, bedrails, bedpans, toilets, bathing tubs, stethoscopes, thermometers — even telephones and remote controls. What’s more, the bacteria produce hardy spores that can persist in a room for weeks or months.
The chance of illness increases with the length of the hospital stay. Symptoms often begin in the hospital, but they can also appear weeks or even months after discharge. In longterm care facilities, older adults may be reinfected so often that C. difficile infections become chronic.

Risk Factors:

Although more people with no known risk factors — including children — are contracting C. difficile infections, your risk is greatest if you:
 Are taking or have recently taken antibiotics.
 Are 65 years of age or older. Older adults have a disproportionately high infection rate. They tend to have more health problems than younger people do and so are more likely to be hospitalized and treated with antibiotics.
 Have a serious underlying illness or weakened immune system. People with weakened immune systems are especially likely to have recurrent infections.
 Are or have recently been hospitalized, especially for an extended period. In general, larger hospitals have higher infection rates than do smaller hospitals.
 Live in a nursing home or longterm care facility. Often, the infection spreads when patients are transferred from hospitals to other facilities.
 Have had abdominal surgery.
 Have a chronic colon disease such as inflammatory bowel disease or colorectal cancer.
 Take prescription or over-the-counter antacids. By reducing stomach acid, these drugs may allow C. difficile to pass more easily into the intestine.
 Have had a previous C. difficile infection.
Contact precautions:
- discontinue antibiotics if appropriate
- don’t share electric thermometers
- consistent environmental cleaning and disinfection
- hypochloride solutions
- handwashing w/soap and water is preferred
Prevention
The most important step in stopping C. difficile infections is to reserve antibiotics for times when they’re really necessary. Every year in the United States, antibiotics are prescribed for viral illnesses that aren’t helped by these drugs. And even some common bacterial ailments such as ear infections or bronchitis may not respond to antibiotics. Taking a wait-and-see attitude with simple ailments may often be the best course.
Other preventive measures you can take include the following:
 If you do need an antibiotic, ask your doctor to prescribe one that has a narrow range and that you take for the shortest time possible. Broad-spectrum antibiotics and those used for more than three to five days are far more likely to disrupt intestinal bacteria.
 Consider taking probiotic supplements — available at natural foods stores and many pharmacies — or eating yogurt before, during and after antibiotic treatment. This helps replace the beneficial bacteria that antibiotics destroy. Only Saccharomyces boulardii has proved effective in C. difficile infections, however.
What hospitals can do
Preventing the spread of C. difficile in healthcare settings has proved a challenging task. The Centers for Disease Control and Prevention (CDC) and various monitoring organizations have issued stringent infection control guidelines.
At a minimum, these measures are recommended:
 Hospital staff wear disposable gloves — and disposable gowns if soiling of clothes is likely — when treating people with C. difficile infections. They wash their hands thoroughly with soap and warm water before and after treating each patient, after removing gloves, and after touching surfaces that might be contaminated. Alcohol-based hand gels, which are commonly used in health care institutions, may not effectively destroy C. difficile spores.
 Visitors wash their hands with soap and warm water before entering and after leaving the room of a patient with a C. difficile infection.
 People who have a C. difficile infection have a private room or share a room with someone who has the same illness.
 All room surfaces are carefully disinfected with a product that contains chlorine bleach.
 If you have a friend or family member in a hospital or nursing home, don’t be afraid to remind caregivers to follow infection control precautions. And be diligent about washing your own hands frequently with soap and warm water.