Clostridium difficile infection
Clostridium difficile infection (CDI), also known as C. difficile disease or C. diff, is an acute gastrointestinal infection caused by the anaerobic, gram-positive bacterium Clostridium difficile. This infection is primarily transmitted through the fecal-oral route, often following the use of antibiotics that disrupt the normal gut flora. Symptoms of CDI can include fever, abdominal pain, nausea, and watery diarrhea, with severe cases potentially leading to complications such as pseudomembranous colitis, toxic megacolon, septic shock, and even death.
Risk factors for developing CDI include advanced age, hospitalization, and the use of certain antibiotics, notably clindamycin, cephalosporins, and fluoroquinolones. Treatment typically involves a course of antibiotics such as metronidazole or vancomycin, although severe cases may require surgical intervention. Since its identification in the late 1970s, CDI has become a significant cause of antibiotic-associated diarrhea, with rising incidence rates prompting increased infection prevention measures in healthcare settings.
Innovative treatments, including fecal microbiota transplants (FMT), have shown promise in effectively treating recurrent CDI, although FMT remains classified as an investigational new drug by the FDA. Understanding CDI is crucial due to its potential severity and the impact it has on public health.
Clostridium difficile infection
ALSO KNOWN AS:C. difficile disease, C. difficile-associated infection, C. diff.
ANATOMY OR SYSTEM AFFECTED: Gastrointestinal system
DEFINITION: An acute, contagious gastrointestinal infection caused by the anaerobic, gram-positive, spore-forming bacillus, Clostridium difficile.
Causes and Symptoms
The Clostridium difficile that cause C. difficile infection are transmitted through the fecal-oral route. These bacteria are shed from feces of a colonized or infected person. When shed, they form spores as a protective mechanism when they enter the environment. They are able to survive in this form for many months on environmental surfaces. C. difficile infection is spread through contact with an infected or colonized patient, the environment, or the contaminated hands of a health care worker. The of C. difficile is unknown; however, one study suggests that it might be less than seven days.
The major for C. difficile infection include advanced age, hospitalization, and use. Nearly every antibiotic has been implicated in C. difficile infection but clindamycin, cephalosporins, and floroquinolones are associated with a higher risk. When a patient receiving antibiotics ingests C. difficile spores, they germinate in the small intestine, where the normal has been altered. The spores multiply, flourish, and produce toxins. The toxins, A and B, cause and mucosal damage leading to colitis. In severe infection, C. difficile can cause toxic megacolon, septic shock, and death.
When a patient becomes infected with C. difficile, fever, abdominal pain or tenderness, anorexia, nausea, and watery commonly occur. In severe infection, the patient may develop pseudomembranous colitis, which may progress to toxic megacolon, a toxic of the colon. If the patient develops toxic megacolon, then sepsis and death may quickly follow.
Treatment and Therapy
Some cases may resolve in two to three days after discontinuing current antibiotic use. However in most cases a ten-day course of metronidazole or vancomycin orally is effective. Surgical intervention may be necessary in severe C. difficile infection if pseudomembranous or develop.
Perspective and Prospects
Before the mid 1970s, pseudomembranous colitis, an inflammatory process in the colon caused by bacterial toxins, was associated with the use of certain antibiotics; mainly lincomycin and clindamycin. It was not until 1978 that C. difficile was identified as the causative agent of antibiotic-associated pseudomembranous colitis. Since that time, C. difficile has become the leading cause of antibiotic-associated diarrhea. Between 2000 and 2007, the rate of C. difficile–related deaths rose 400 percent. The Centers for Disease Control and Prevention (CDC) reported in 2016 that 29,000 people in the United States died within thirty days of diagnosis of such infections in 2011. Moreover, a hypervirulent called BI/NAP1/027 has emerged. This strain produces a type of toxin not previously seen in other strains; it is also highly resistant to the fluoroquinolone antibiotics. Many health care facilities have adopted infection prevention measures since 2010; the CDC reported an 8 percent decrease in health-care associated C. difficile infections between 2011 and 2014.
The American College of Gastroenterology reported in 2012 that while studies have shown that fecal microbiota transplants (FMT) were effective in 91 percent of C. diff patients who had them. Controlled trials of the treatment have shown promise, as reported by The Lancet in 2022. The US Food and Drug Administration has classified FMT as an investigational new drug and was exercising discretion in allowing doctors to use FMT to treat patients with C. diff infections that have not responded to standard therapies, as long as the doctor has stated that FMT is investigational, has discussed potential risks of the treatment with the patient, and has the patient’s adequately informed consent.
Bibliography
Baunwall, Simon Mark Dahl, et al. "Faecal Microbiota Transplantation for First or Second Clostridioides difficile Infection (EarlyFMT): A Randomised, Double-Blind, Placebo-Controlled Trial. The Lancet Gastroenterology & Hepatology, vol. 7, no. 12, 2022, pp. 1083-1091, doi.org/10.1016/S2468-1253(22)00276-X. Accessed 28 Mar. 2024.
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Centers for Disease Control and Prevention. “Healthcare-Associated Infections (HAIs): Clostridium difficile Infection.” CDC.gov, 1 Mar. 2016. Web. 28 Apr. 2016.
Centers for Disease Control and Prevention. “Healthcare-Associated Infections (HAIs) Progress Report.” CDC.gov, 3 Mar. 2016. Web. 28 Apr. 2016.
Centers for Disease Control and Prevention. “Your Risk of C. diff.” CDC.gov, 27 June 2022, www.cdc.gov/cdiff/risk.html. Web. Accessed 1 Aug. 2023.
McCoy, Krisha. “Antibiotic-Associated Colitis—C. difficile.” Health Library. EBSCO Information Services, 9 Feb. 2016. Web. 28 Apr. 2016.
Surawicz, Christina M. “C. difficile Infection.” American College of Gastroenterology Patient Education & Resource Center, Dec. 2012.
United States. Food and Drug Administration. “Guidance for Industry: Enforcement Policy Regarding Investigational New Drug Requirements for Use of Fecal Microbiota for Transplantation to Treat Clostridium difficile Infection Not Responsive to Standard Therapies.” FDA.gov. FDA, July 2013. Web. 28 Apr. 2016.
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