Clostridium difficile – C Diff
Learn about the new Superbug C Diff.
By R. Mark Mellow, M.D., medical director, INTEGRIS Digestive Health Center
Clostridium difficile – C Diff for short – is fast emerging as a health threat rivaling and perhaps surpassing the severe staph infection, MRSA, in frequency and severity. First discovered in the 1970s as a cause of diarrhea in hospitalized patients requiring antibiotics (in fact, the condition was called antibiotic associated colitis), the Centers for Disease Control reports there were 500,000 cases of C Diff in the United States this year, up from 150,000 cases in 2001, with an annual death toll exceeding 15,000. C Diff is now the most common cause of infectious diarrhea in hospitals and long term care settings.
Who is at risk for C Diff?
In prior years, the vast majority of cases occurred in elderly patients who were hospitalized and receiving antibiotics for other infections (for example, pneumonia). These patients are still at highest risk to contract D Diff, but no one is immune. Community acquired C Diff is dramatically on the rise. Otherwise healthy people are being hospitalized with C Diff colitis, both young and old.
Why is C Diff incidence and severity increasing?
Many patients get C Diff infections as an unintended consequence of taking antibiotics for other illnesses. “Good” bacteria, normally found in a person’s intestines, help keep C Diff under control, allowing the bug to live in the gut without causing illness. But when a person takes antibiotics, both good and bad bacteria are suppressed, allowing C Diff to grow out of control, since C Diff is resistant to most antibiotics that are used to treat common infections.
Additionally, a new strain of C Diff has emerged, NAP/0127, which produces a more severe colon infection. First identified in Canada, it has spread to all 50 states in the United States.
Want more bad news?
Once you get C Diff, it’s getting much harder to get rid of it. Initial treatment involves use of special antibiotics, Metronidazole or Vancomycin, for 10-14 days; Vancomycin being more effective than Metronidazole in patients with severe disease. Worse yet, C Diff recurrence rates are at approximately 20 percent in severe cases, meaning even after completing treatment, you have a one in five chance of it coming back in full force! If you get one recurrence, the chance of getting one or more further recurrences is more than 50 percent, with each recurrence leading to more sickness and debility.
What can you do to avoid C Diff or at least identify it and treat it early?
1. Avoid “casual” antibiotic use. Because you have a stuffy nose, don’t demand antibiotics. Most upper respiratory infections are viral and will not be improved by antibiotic use.
2. Practice careful “hand hygiene” at all times.
3. Contact your physician if you get diarrhea while taking an antibiotic and be sure a stool specimen gets tested for C Diff.
What can be done to prevent hospital acquired C Diff?
At INTEGRIS Baptist Medical Center, we have formed a War on C Diff committee and in conjunction with the Infection Control committee and medical and nursing staff, we have instituted several policies to prevent C Diff and detect it early if it occurs. Since this is an intestinal infection, it is spread by the fecal-oral route. Good hand hygiene must be practiced by staff and visitors. Special soap dispensing stations are available throughout the hospital and in patients’ rooms. Everyone – doctors, nurses, visitors, etc. – needs to clean hands before and after visits. Unfortunately, the usual alcohol based washes are not effective – chlorhexidine soap must be used.
Patients are isolated in a private room as soon as C Diff is suspected, and gowns and gloves are worn before entering the room. We have enlisted the nursing staff as front line detectives in the war on C Diff. They may obtain a stool specimen from a patient anytime they suspect C Diff, and not just wait for a physician to discover the problem. This could give us one to two day’s lead time in identifying a patient with C Diff, allowing earlier treatment and isolation so he/she cannot spread the C Diff to others.
Through the INTEGRIS Digestive Health Center, INTEGRIS Baptist Medical Center has secured a research grant from the National Institute of Probiotics to see if use of probiotic capsules, given to hospital patients needing antibiotics to treat their infections, will prevent C Diff. Probiotics are the “good” bacteria present in all of our intestines. As stated before, antibiotics destroy both bad and good bacteria. We are hopeful that by replenishing their good bacteria, in capsule form, we will prevent C Diff infection. Encourage your friends and relatives to participate in this project if they are asked to do so.
Additionally, the War on C Diff committee has developed a treatment guideline, which focuses on identifying patients at highest risk to develop severe C Diff, and is initiating special treatment measures, which include the consideration of the use of fecal transplant.
What is fecal transplant?
Just what it sounds like: taking a stool sample of a healthy relative of an infected person, liquefying and infusing it into the colon of a sick patient, typically by means of a colonoscopy. The theory is good bacteria in the healthy stool specimen will repopulate in the patient’s colon and help eradicate the C Diff. While experience with this therapy is limited in the ill hospitalized patient, innovative measures are desperately needed. A recent medical study reported that if someone in the hospital contracts C Diff and becomes sick enough to be transferred to an intensive care unit, their chance of dying is 52 percent!
Fecal transplants have been used very effectively in patients with recurrent C Diff. More than 1,000 such procedures have been performed in Australia, with a higher than 90 percent success rate, and similar results have been reported in Scandinavia. Initial American experiences are equally impressive. For fecal transplants, the donor is tested just as a blood donor would be, with blood and stool testing to exclude transmissible diseases. If you, a relative or a loved one has experienced a recurrence of C Diff, contact us at 405-713-4430 for further information on this treatment.
The Digestive Health Center provides comprehensive, integrated care in one convenient location. For more information on digestive health, call 405-951-2277.