Clostridium Difficile Infection

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KEY POINTS

• Clostridium difficile is a bacteria that infects the bowel and causes severe diarrhea.
• Dehydration caused by diarrhea can be very dangerous. You need to drink enough liquid to replace the fluids and minerals lost.
• Treatment may include antibiotics, or in rare cases, surgery.

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What is Clostridium difficile infection?

Clostridium difficile (C. diff) is a bacteria that can cause diarrhea. You can have some of these bacteria in your intestines without getting sick. However, if you have too many, they can damage your colon (the large intestine) and cause mild diarrhea or a serious, even life-threatening infection.

What is the cause?

You can get C. diff bacteria from the bowel movements of an infected person. The bacteria can pass from one person to another if someone has touched a surface that has C. diff on it and does not wash his hands. The bacteria can live for many hours on surfaces such as toilet seats, door knobs, and bathroom fixtures.

You may get a C. diff infection if you have been taking antibiotic medicine to treat an infection caused by other bacteria. Taking antibiotic medicine can upset the natural balance of "good" and "bad" bacteria in your intestines. When an antibiotic medicine kills too many “good” bacteria, it may let C. diff bacteria grow in your intestines and cause an infection.

You are more likely to get a C. diff infection if:

• You have recently been cared for in a hospital or long-term care facility.
• You have a medical condition that lowers your ability to fight infections, such as diabetes or cancer, or if you have an illness that causes you to take antibiotic medicine often.
• You are 65 or older.
• You have a history of colon problems, such as cancer or inflammatory bowel disease.

What are the symptoms?

Symptoms may include:

• Watery diarrhea, which may be bloody or painful if you have a serious illness
• Fever
• Loss of appetite
• Nausea
• Belly pain and tenderness

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Your bowel movements may be tested for bacteria. These tests can also show which antibiotics are best to treat the infection.

You may have these tests to see if the infection is damaging your colon:

• CT scan, which uses X-rays and a computer to show detailed pictures of the organs inside your belly
• Sigmoidoscopy or colonoscopy, which uses a thin, flexible tube and tiny camera put into your rectum and up into the colon to look inside the colon

How is it treated?

For mild symptoms caused by an antibiotic you have been taking for another infection, your provider may have you stop taking the medicine that caused this problem. For more severe symptoms, you may need to be treated with an antibiotic that kills C. diff.

If the lining of your colon has been badly damaged by the infection, you may need surgery to remove the injured part of the colon.

How can I take care of myself?

• Follow your healthcare provider’s instructions. Take all medicines exactly as prescribed. If you stop taking the antibiotic too soon, your infection may come back.
• If you have mild symptoms, here are some things you can do to feel better:
  • Rest your stomach and bowel but make sure that you keep getting fluids. You can do this by not eating anything and by drinking clear liquids only. Clear liquids include water, weak tea, fruit juice mixed half and half with water, Jell-O, or clear soft drinks without caffeine (like lemon-lime soda.) Stir soda until the bubbles are gone (the bubbles can make vomiting worse). Avoid liquids that are acidic, like orange juice, or have caffeine, like coffee. Don’t drink milk or eat dairy products (for example cheese or ice cream) when you have diarrhea.
  • You may eat soft, plain foods. Good choices are soda crackers, toast, plain noodles, or rice, cooked cereal, applesauce, and bananas. Eat slowly and avoid foods that are hard to digest or may irritate your stomach, such as foods with acid (like tomatoes or oranges), spicy or fatty food, meats, milk products, and raw vegetables. You may be able to go back to your normal diet in a few days.
  • Don’t take aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) without checking first with your healthcare provider. NSAIDs, such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, you should not take this medicine for more than 10 days.
• If you have severe diarrhea, your body can lose too much fluid and you can get dehydrated. Dehydration can be very dangerous, especially for children and older adults. You may also be losing minerals that your body needs to keep working normally. Your healthcare provider may recommend an oral rehydration solution, which is a drink that replaces fluids and minerals. If your diarrhea is getting worse, contact your healthcare provider.

Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

• Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent C. diff infection?

C. diff can be a serious health threat to you and the people around you. It cannot be treated with the usual antibiotics used to treat infections. Prevention is very important. Do not use antibiotic medicine for viral colds and flu.

If you have C. diff, you can avoid passing it to others by cleaning your hands well with soap and water. Everyone who comes in contact with you must also clean their hands before and after seeing you. While you have diarrhea, you should use a toilet that is not used by anyone else.

To avoid getting a C. diff infection:

• Wash your hands every time you use the bathroom and every time before you have a snack or eat a meal.
• Take antibiotics only when needed and only as directed by the healthcare provider who is treating your C. diff infection. Finish prescriptions, even if you feel better. If you stop taking the medicine too soon, you may not kill all of the bacteria and you may get sicker.
• If you are being treated at a hospital, make sure that all doctors, nurses, and other healthcare providers clean their hands with soap and water before and after caring for you. If you do not see your providers clean their hands, ask them to do so.

If you are at high risk for infection, you may be given medicine that may help you have a healthy balance of bacteria in your colon. Research continues on substances like probiotic bacteria to see if they can help prevent or treat C. diff.