Clostridium difficile

What is Clostridium difficile?

C. difficile is short for Clostridium difficile - is a bacterium that lives in the large bowel. A small number of adults have C. difficile in their large bowel but it doesn't make them ill because it's controlled by other types of bacteria. Most babies and young children have C. difficile in their large bowel, but it doesn't usually have a harmful effect. It's also more commonly found in the elderly.

The bacterium can survive for long periods of time outside the body by creating spores. These cells can resist extremes of temperature and drying. They are only destroyed by cleaning thoroughly with soap and water or high level disinfectant.

What causes C. difficile?

If you have C. difficile infection, it's likely that you are taking antibiotics for another illness. These medicines destroy the bacteria which usually stop C. difficile from causing any problems. You are more at risk if you are taking broad spectrum antibiotics (antibiotics that can be used to treat a wide range of conditions). These antibiotics can also change the balance in your bowel, resulting in the development of C. difficile diarrhoea.

C. difficile spores are found in the diarrhoea of people who have C. difficile infection and can be passed on. This may be through hand-to-hand contact with patients or healthcare staff who come into contact with infected patients, and also from contaminated objects such as bedpans, toilets or surfaces.

C. difficile bacteria produce two toxins which damage the cells that line your bowel. This means that the cells can't function properly to absorb digested food and this leads to diarrhoea.

The infection is much more common in older people - as many as eight out of 10 people who develop it are over the age of 65. You may also be at an increased risk if you have had surgery to your digestive system or if you have a condition that means your immune system isn't able to fight infection as well as that of a healthy person.

What are the Symptoms of C. difficile

Your symptoms will vary depending on how seriously you are infected. The main ones include:
• diarrhoea
• abdominal pain
• fever
• loss of appetite
• feeling sick

In some people C. difficile can cause inflammation and bleeding in the large bowel. This is called pseudomembranous colitis. Rarely, C. difficile may also lead to your bowel perforating (tearing) and inflammation of the inside of your abdomen (tummy). Sometimes C. difficile infection can be fatal.

How is the infection treated?

If you have a mild C. difficile infection, the only treatment you may need is to stop taking the antibiotics that are causing the disruption of your bowel's usual bacteria. You are likely to need treatment to replace the fluid that you will have lost as a result of having diarrhoea. You may be able to take this by mouth or you may need to have a drip put into a vein.

If you have a more serious infection, you will probably be prescribed a different antibiotic such as metronidazole or vancomycin. You will need to take this for at least 10 days. Even if these antibiotics get rid of the infection, there is a possibility that it will come back. This happens to about one in five people who develop the infection. This is because C. difficile spores are often resistant to treatment with antibiotics and are difficult to destroy. You may be prescribed the same antibiotic again or a different treatment.

How can I keep from getting C. difficile?

If you are infected with C. difficile or have been in contact with someone who has the infection, it's very important that you take steps to avoid spreading the disease to anyone else, particularly elderly people or others who may be at an increased risk. You can do this by making sure you always wash your hands with soap and water after going to the toilet and before preparing food or eating. In addition, regularly clean kitchens and bathrooms using a high level disinfectant.