Clostridioides difficile (commonly known as C. diff) is a bacterium (germ) that can cause severe diarrhea and inflammation of the large intestine (colitis). The U.S. Centers of Disease Control and Prevention (CDC) has labeled C. diff as a major health threat because of the possible severity of symptoms, potential for antibiotic resistance, recurrence, and risk of death. There are an estimated half-million C. diff infections in the U.S. each year, and the infection is associated with 15,000 to 30,000 U.S. annual deaths.
The incidence of C. diff infection has increased over the last 20 years and has become the most commonly identified cause of healthcare-associated infections among U.S. adults.
C. diff and Multidrug Resistance
C. diff is challenging to treat because the bacteria may survive typical antibiotic treatment (antibiotic resistance), leading to infection relapse post therapy. In recent years, several strains of C. diff bacteria have grown resistant to multiple antibiotics (multiple drug resistance/MDR), leading to outbreaks that are particularly severe and more difficult to treat. C. diff is known to be resistant to aminoglycosides, tetracyclines, erythromycin, clindamycin, penicillins, cephalosporins, and fluoroquinolones, which are commonly used to treat bacterial infections.
These stronger, more severe C. diff strains (known as hypervirulent strains) are responsible for severe infections with a high rate of recurrence, resistance to treatment, and deaths in the U.S. and worldwide. C. diff infection presents tremendous challenges to healthcare providers and healthcare facilities because of the twin problems of both preventing C. diff spread and effectively treating C. diff infection. The yearly cost of C. diff infection in the U.S. is estimated to be $5.4 billion. Repeat C. diff infection is estimated to cost $2.8 billion annually—about half of all C. diff costs.
Most cases of C. diff occur in patients taking antibiotics. Using antibiotics wisely can help prevent the spread of C. diff by reducing unnecessary use of antibiotics.
- Antibiotics only work on bacteria; they do not treat illnesses caused by viruses (e.g., flu or colds)
- Trust your providers’ recommendations on whether you need antibiotics; don’t demand an antibiotic prescription
- Never share your antibiotics with others
- If you are prescribed antibiotics, always finish the entire prescription unless your provider advises you to stop
- Contact your healthcare provider if you develop diarrhea while taking antibiotics
Who is Vulnerable to C. diff ?
Known risk factors for initial C. diff infection include recent antibiotic therapy, age over 65, longer length of stay in a healthcare setting, underlying chronic illnesses such as inflammatory bowel disease and immunocompromised conditions. Risk factors for repeat C. diff infection are largely the same, but also include previous C. diff infection severity and presence of a highly virulent strain. Approximately 20% to 30% of C. diff patients have recurrence of infection, which increases their risk of relapse.
Available Treatment Options for Multidrug resistantC. diff
The recommended treatments for primary and recurrent C. diff infection are the antibiotics vancomycin and fidaxomicin. But if patients experience multiple recurrences and fail antibiotic treatments, fecal microbiota transplant (FMT) is an alternative option. In FMT, stool containing healthy microbial communities from healthy donors are transferred to someone with repeated C. diff infection. FMT is approved by the FDA to prevent recurrence of C. diff in individuals 18 years of age and older, and is used after an individual has completed antibiotic treatment for recurrent C. diff. FMT has been shown to have a 80%-90% success rate in preventing C. diff recurrence.
The problem of C. diff antibiotic resistance has made the development of better preventive strategies, more targeted use of antibiotics, and reducing the number of patients who experience repeat episodes of C. diff more important than ever.
Why is it important to understand C. Diff ?
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We have presented you with three articles (this one included) about C. Difficile infections:
- Understanding your risk for C. Diff infection
- Patients with IBD are at increased risk for C. Diff infection
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Jacqueline Syrop is a health editor and writer specializing in information for patients and their caretakers. You can find her on Linkedin.