Clostridium difficile

What is Clostridium difficile?

C. difficile is a spore forming bacteria which can be part of the normal intestinal flora in as many as 50% of children under age two, and less frequently in individuals over two years of age. C. difficile is the major cause of pseudomembranous colitis and antibiotic associated diarrhea.

What are the risk factors for C. difficile-associated disease?

C. difficile-associated disease occurs when the normal intestinal flora is altered, allowing C. difficile to flourish in the intestinal tract and produce a toxin that causes a watery diarrhea. Repeated enemas, prolonged nasogastric tube insertion and gastrointestinal tract surgery increase a person's risk of developing the disease. The overuse of antibiotics, especially penicillin (ampicillin), clindamycin and cephalosporins may also alter the normal intestinal flora and increase the risk of developing C. difficile diarrhea.

What are the symptoms of C. difficile-associated disease?

Mild cases of C. difficile disease are characterized by frequent, foul smelling, watery stools. More severe symptoms, indicative of pseudomembranous colitis, include diarrhea that contains blood and mucous, and abdominal cramps. An abnormal heart rhythm may also occur.

How is C. difficile-associated disease diagnosed?

C. difficile diarrhea is confirmed by the presence of a toxin in a stool specimen. A positive culture for C. difficile without a toxin assay is not sufficient to make the diagnosis of C. difficile- associated disease. Endoscopic findings are useful in diagnosis of pseudomembranous colitis.

What is the treatment for C. difficile-associated disease?

As soon as C. difficile disease is diagnosed, current antibiotic therapy should be reassessed by the physician. Patients with severe toxicity or unresolved diarrhea may need to have their antibiotic treatment modified to use drugs not known to result in C. difficile diarrhea. Patients should be monitored for dehydration and electrolyte imbalance following prolonged bouts of diarrhea. Antidiarrheal agents such as Lomotil® or Imodium® have been shown to increase the severity of symptoms and should NOT be taken.

How can C. difficile-associated disease be spread?

Individuals with C. difficile-associated disease shed spores in the stool that can be spread from person to person. Spores can survive up to 70 days in the environment and can be transported on the hands of health care personnel who have direct contact with infected patients or with environmental surfaces (floors, bedpans, toilets etc.) contaminated with C. difficile.

How can C. difficile-associated disease be prevented?

Strict adherence to hand washing techniques and the proper handling of contaminated wastes (including diapers) are effective in preventing the spread of the disease. Environmental surfaces contaminated with C. difficile spores should be cleaned with an effective disinfectant (bleach). Limiting the use of antibiotics will lower the risk of developing C. difficile diarrhea.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.