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Clostridium difficile


Clostridium difficile

Clostridium difficile, C. difficile or C. diff, is a bacterium that can cause a serious infection of the digestive tract. C. difficile infection can be due to Antibiotic Treatment that kills off the normal (beneficial) microbes that live in the GI tract, these microbes are also called normal flora. This can cause Microbial Dysbiosis and Antibiotic Associated Diarrhea - AAD. Approximately 25% of AAD cases is caused by Clostridium difficile Infection.[7]

Clostridium difficile are often spread via ingestion (eating) and when normal flora are killed off by antibiotics, the C. difficile bacteria can invade the gut lining and can cause a wide range of symptoms that may be mild to life-threatening. [1][2] The majority of C. difficile infections are related to exposures related to health care settings (94%), although onset of symptoms may occur outside of a hospital setting. [4]

Clostridium difficile infection can cause:
- No symptoms [2]
- Bloating [2]
- Diarrhea [1][2]
- Fever [1][2]
- Nausea [2]
- Pain [1] / Cramping [2] in the abdomen
- Pseudomembranous colitis [2]
- Toxic megacolon [2]
- Death [2]

Why is Clostridium difficile infection of concern?

1. Clostridium difficile forms "spores"
The Clostridium difficile bacteria can form "spores", which are a dormant form with a very hard outer shell allowing them to survive in environments that would normally kill other bacteria. These spores essentially allow C. difficile to live forever in the dormant state. When the spore enters an enviornment that is favorable for it to survive and grow (for example after the spores are eaten by a patient), they enter the "vegetative" state where they grow and multiply.

- No disinfectant can kill Clostridium difficile spores
There are no Environmental Protection Agency (EPA) disinfectants that are known to kill C. difficile "spores", including bleach.[2] Certain cleaners that are often used in hospital situations can actually drive C. difficile to form the heartier spore-state and promote persistance of the bacteria. The most effective cleaning agent for C. difficile was found to be a combination of detergent and bleach [3][5]

2. Clostridium difficile produces toxins
Toxins produced by C. difficile can damage the colon. [2]

3. Clostridium difficile can be antibiotic-resistant

4. Clostridium difficile infection has high rates of relapse[2]

5. There are no Environmental Protection Agency (EPA) disinfectants that are known to kill Clostridium difficile "spores", including bleach. [2]

Guidelines to Prevent Clostridium difficile Infection and Spread

- Clean surfaces with bleach-containing disinfectants (sodium hypochlorite)
- Cleaning should be performed more often on high patient-contact items such as, light switches, toilet flush lever, etc.
(*Note: Cleaning with bleach can cause some white plastics to yellow)
(*Safety Note: NEVER mix bleach and ammonia-containing cleaners (lysol,etc.). It will form a toxic gas that can be fatal)

- Wash hands immediately following patient contact or patient's room
- Wash hands before exiting the patient's room if possible.
- Minimize contact with C. difficile infected patient until 48 hours after diarrhea resolves.

Treatment of Clostridium difficile

- Stop causal antibiotic
- Flagyl - Metronidazole or Vancomycin for treatment of Clostridium difficile
- Rifaximin [6]



2. Sunenshine RH and McDonald LC Clostridium difficile-associated disease: New challenges from an established pathogen. Cleve Clin J Med. 2006;73:187-197.


4. CDC MMWR Mar 6, 2012

5. Dawson LF, Valiente E, Donahue EH, Birchenough G, and Wren BW (2011) Hypervirulent Clostridium difficile PCR-Ribotypes Exhibit Resistance to Widely Used Disinfectants. 6(10):1-7.

6. Koo HL, Garey KW, DuPont HL. Future Novel Therapeutic Agents for Clostridium difficile Infection. Expert Opinion on Investigational Drugs. 2010; 19(7): 825-836.

7. Ayyagari A, Agarwal J, Garg A. Antibiotic associated diarrhoea: Infectious causes. Indian J Med Microbiol 2003;21:6-11.


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