What is C. difficile?

Clostridium difficile, sometimes referred to as C. difficile or C. diff, is one of many types of bacteria that naturally occur in your intestine. C. difficile coexists with as many as 1,000 microorganisms in your digestive tract and is usually harmless as long as those bacteria exist in a healthy balance.

What causes C. difficile infection?

When something upsets the balance of good versus harmful bacteria in the bowels, an overgrowth of the C. difficile bacteria can occur, leading to infection. The most common reason for the overgrowth of C. difficile is the use of antibiotics. Antibiotics are medications that fight bacterial infections. But, while antibiotic use can fight one type of infection, such as strep throat, they can simultaneously destroy some of the healthy bacteria needed to keep the C. difficile bacteria in check. This suppression of healthy bacteria allows the C. difficile bacteria to quickly grow out of control. As a result, toxins are released that attack the lining of the intestines causing the colon to become inflamed.

At-risk populations for C. difficile infection

The risk for C. difficile infection increases for those:

  • With inflammatory bowel disease (Crohn’s disease or ulcerative colitis)

  • On prolonged doses of antibiotics

  • With weakened immune systems, including the elderly or those living with severe illness

  • Undergoing cancer chemotherapy

  • With extended stays in a hospital or a long-term care facility

Containment of C. difficile

C. difficile is the leading cause of infectious diarrhea and a common infection acquired in the hospital environment.

C. difficile infection can be easily spread to others when a person comes into contact with any surface, such as toilets, bathtubs, or clothing that are contaminated with fecal material. The infection can live on surfaces for long periods of time. The infection is also easily spread from person to person through contaminated instruments, clothing, and poor hand-washing by hospital staff.

The best preventative measures include:

  • Washing hands thoroughly with soap and water

  • Clean suspected surfaces with bleach-based products

  • Wash soiled clothing with detergent and chlorine bleach

  • Use antibiotics only when your doctor recommends them.

Symptoms of Infection

Symptoms vary depending on severity of the infection.

Mild to moderate symptoms include:

  • Watery diarrhea several times a day for several days in a row

  • Mild abdominal cramping and tenderness

A severe infection might also include:

  • Fever

  • Dehydration

  • Swollen abdomen

  • Abdominal pain

  • Nausea

Possible complications from C. difficile

A severe C. difficile infection that is untreated can cause life-threatening consequences. The Centers for Disease Control (CDC) estimates that C. difficile infection is linked to approximately 29,000 American deaths each year that stem from severe diarrhea. Adults age 65 and older account for more than 80% of these deaths. Other possible complications include:

  • Dehydration and low blood pressure due to loss of body fluids and electrolytes
  • Kidney failure due to severe dehydration
  • Perforation (a hole) in the colon, which can spread the infection to the abdominal cavity
  • Toxic megacolon, which is a severe swelling of the colon that could cause the colon to rupture.

Treatment of C. difficile infection

The most common treatments are select antibiotics that suppress the growth of the C. difficile infection including the following medications:

  • Metronidazole

  • Vancomycin

  • Fidaxomicin

Typically, one of these oral antibiotics is prescribed for at least 10 days to bring the overgrowth of C. difficile under control.

Recurrent C. difficile infection

Unfortunately, about 25% of C. diff patients have a recurrence of C. difficile after antibiotics are discontinued. Older adults are especially at risk for multiple recurrences of the infection. Recurrent C. difficile infections are more difficult to treat since the risk of recurrence continues to rise with each subsequent recurrence.

Another treatment that has shown promise in treating recurrent C. difficile infection is an Ecobiotic® therapy called SER-109 by Seres Therapeutics. SER-109 is a preparation of bacterial spores highly purified from stool donations obtained from healthy, screened donors and put into capsules. These bacterial spores are inactive forms of the normal bacteria that live in a healthy intestine. SER-109 is a new investigational research medication (still in clinical trials) being studied to determine if providing normal healthy bacteria (via SER-109) to patients with recurrent Clostridium difficile infection can help replenish natural organisms in the intestines to help prevent recurrent Clostridium difficile infection. In clinical trials, patients with C. diff infection take SER-109 a few days after discontinuation of their antibiotics.

The Food and Drug Administration (FDA) designated SER-109 as a Breakthrough Therapy in 2015, which means this research medication receives priority review from the FDA.

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