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Antibiotic associated C. Difficile / C Diff Infection

Antibiotic-Associated Clostridium difficile Infection

About an antibiotic-associated C. difficile infection

Clostridium difficile

Contamination pathways

 Antibiotic/Other medication involvement in C. Difficile infections

 Recurrence of C. Difficile infections


About an antibiotic-associated C. difficile infection


      Antibiotic use allows infecting C. difficile bacteria to take-over intestines and wreak havoc -  causing damage, inflammation and severe diarrhea


      C. difficile is an infectious, antibiotic-resistant, toxin-producing bacteria (usually accidently ingested in a hospital, nursing home, assisted-living or similar community facility) -  C. Diff overruns the normal gut flora (most often in immuno-compromised /elderly patients) after this beneficial flora has been wiped out by a broad spectrum antibiotic 


      C. difficile infection is sometimes misdiagnosed as Irritable Bowel Syndrome (IBS) or the stomach flu


C. difficile


      C. difficile is an anaerobic, gram positive, spore-forming bacillus


      The overpopulating C. difficile bacteria release toxins (Toxin A and Toxin B) that damage / inflame the lining of the intestines - causing bloating and severe diarrhea (C. difficile-associated diarrhea / CDAD) with abdominal pain:


         The toxins destroy the normal colon cells and produce pseudomembranes - which are visualized on colonoscopy as yellowish-white plaques of inflammatory cells on the interior surface of the colon;


         Can lead to infection of the colon  - identified as C. difficile colitis or Pseudomembranous colitis, promoting severe inflammation;


         CDAD is a major cause of morbidity, especially in the elderly - and C. difficile infections have dramatically increased in recent years, with 500,000 cases and ~15,000 deaths annually in the U.S., according to the U.S. Centers for Disease Control & Prevention. A compromised immune system and delayed diagnosis appear to be factors in an elevated risk of death;


         This infection is adding significantly to hospitalization costs – currently over $1 billion/year in the U.S. - C. difficile is acquisitioned in 13% of patients with hospital stays of up to 2 weeks, and 50% in those with hospital stays longer than 4 weeks.



      Clostridia bacteria are normally found in small amounts in the small intestine ileum and colon it is rarely found in the oropharynx, stomach, or small intestine jejunum


Contamination pathways


         C. difficile can be acquired from a carrier and spread by direct or indirect contact - with contaminated surfaces or air-borne spores.


         The heat-resistant spores can survive outside the body and remain viable for weeks on surfaces - such as bed rails, blood pressure cuffs, thermometers, tabletops, telephones, stethoscopes etc. The organism can persist in hospital rooms for up to 40 days after infected patients have been discharged.

Hurley  BW, Nguyen  CC.  The spectrum of pseudomembranous enterocolitis and antibiotic-associated diarrhea.  Arch Intern Med.  2002;162:2177–84.

Another source says C. Diff can survive 5 months even on a dry surface.

Kramer A, et al. BMC Infect Dis 2006;6:130


         The many spores formed by C. difficile resist most surface cleaning methods  - but there are cleaning solutions that will “get ‘em”


Cleaning solutions for C. Diff


         The spores are commonly spread from one patient to another - via unwashed hands of caregivers or via tubal insertions into the body (E.g. via nasogastric tubes or administration of enemas /enteral feedings).


Antibiotic/Other medication involvement in C. Difficile infections


      Broad spectrum antibiotics (E.g.  clindamycin, (Cleocin), fluoroquinolones: ciprofloxacin (Cipro) and levofloxacin (Levaquin), cephalosporins: Ceftin, Omnicef, Rocephin, Maxipime) are more strongly associated with C. difficile infections than other antibiotics;


      Increasing rates of community-acquired (nosocomial) C. difficile infection are associated with the use of medication that suppress gastric acid production


          H2-receptor antagonists increased the risk 1.5 fold, and proton pump inhibitors by 1.7 with once daily use and 2.4 with more than once daily use.


         All anticholinergic drugs (E.g. the PPI Omeprazole) slow digestive transit time, and so retain toxins to exacerbate gut damage.


Recurrence of C. difficile


      Occur in ~20% of cases -  usually within 2 months after stopping antibiotics for CDAD;


      Usually due to reinfection or germination of spores in colon;


      Who is likely to have C. difficile recurrence?  




         Patients who have one recurrence  - 65% more likely to have further recurrences;



HEALTH PROBLEM TREATMENT LINKS Antibiotic associated C. Difficile / C Diff Infection - Links





 – Antibiotic-associated Infection

About C. Difficile Infection

-  Symptoms

-  Prevention

-  Cleaning Solutions for C. Diff


About Treatment of C. Difficile

-  Mainstream medicine

-  Probiotics

-  Probiotic / Antibiotic Dosages

-  Prevent reinfection

-  Natural pathogen killers

-  Therapy   -  Discontinue antibiotics

                       and Administer Fluids/Electrolytes

-  Other treaments