Clostridium difficile (“C-diff”) is a gram-positive, spore-forming bacterium. It lives in the colon where it is normally in equilibrium with the other bacteria that live there.  Antibiotics used to treat infections elsewhere in the body can disrupt the normal bacterial equilibrium of the colon and allow Clostridium difficile to overgrow and begin producing toxins.  This results in Clostridium difficile infection and causes colitis or inflammation of the colon.  Around 1% of all patients admitted to the hospital will get a Clostridium difficile infection.

Factors that increase the chance of getting Clostridium difficile infection are:

1. Previous use of antibiotics
2. Older  age (persons > 65 years have a higher infection rate)
3. Hospital admission or residence in a long-term care facility
4. Use of certain antacid medications 

The main symptom of Clostridium difficile infection is diarrhea, but fever, nausea, fatigue, dehydration, and abdominal discomfort may also occur.   The easiest way to detect a Clostridium difficile infection is by testing a stool sample.  Different tests can return results within 1-3 days. 

Treatment involves stopping any antibiotics that may have triggered the Clostridium difficile infection as soon as possible.  There are also several antibiotics that target Clostridium difficile itself; these are metronidazole, vancomycin (only the oral form, the intravenous form is not effective), and fidaxomicin.  These antibiotics are normally taken for 10-14 days.  Clostridium difficile infection can recur after a course of treatment, and different regimens may be used to treat recurrent infection.

In 3-8% of cases, Clostridium difficile colitis can become very severe and can affect the entire body. When this happens it is a life-threatening situation.  If severe Clostridium difficile colitis does not improve with antibiotics, surgery may be necessary.  Surgery usually involves removing the majority of the colon and performing an ileostomy, where the intestinal contents empty into a plastic appliance attached to the abdominal wall.  Another technique involves making an ileostomy, and using it to irrigate out the colon and directly deliver antibiotics into the colon, rather than removing the colon entirely.

While these severe cases are relatively rare, the overall rate of C. difficile infection in the United States is on the rise.  This rate can be kept to a minimum by using antibiotics only when necessary, careful environmental and hand cleaning, and isolating patients with Clostridium difficile infection from those who are not infected, among other tactics.  In addition to these prevention strategies, a variety of new treatment and prevention strategies are being researched, from new antibiotics, to fecal bacteriotherapy (“stool transplant” in which bacteria from one person’s intestines are given to another person to help restore bacterial intestinal equilibrium), to antibodies against Clostridium difficile toxins, to vaccines.  These will hopefully limit the impact of Clostridium difficile infection in the future.

Gwendolyn M. van der Wilden
Peter J. Fagenholz, MD