Clostridium difficile
Clostridium difficile (CDF or C. diff) are a type of hospital-acquired bacteria. The bacteria were identified as the cause of diarrhoea and colitis due to treatment with certain types of antibiotics in hospitals about thirty years ago and continue to be a major concern to this day.
What is Clostridium difficile?
Clostridium difficile normally live alongside other bacteria in the human gut in about five per cent of the healthy adult population. When a patient is treated with a particular type of antibiotic, much of their healthy gut bacteria are destroyed. This allows Clostridium difficile to grow out of control, which causes diarrhoea.
The severity of diarrhoea symptoms can be mild, but in some cases a very severe illness with ulceration and bleeding from the colon can develop (colitis). In the most serious of infections the ulceration can perforate the intestine and lead to peritonitis, which can be fatal.
There were 8,324 death certificates that mentioned Clostridium difficile in 2007 - a 28 per cent increase on 2006 figures (1).
Who can catch Clostridium difficile?
People affected by the more serious symptoms of Clostridium difficile infection include elderly patients with other illnesses and patients with damaged or suppressed immune systems (HIV-infected patients and those on immuno-modulating drugs). Most infections occur in hospitals and nursing homes, but some can also happen in other healthcare settings outside of hospitals, such as a GP’s surgery or clinic.
Aren’t antibiotics supposed to cure infections?
Patients at risk of infection with Clostridium difficile are those who have been treated with broad spectrum antibiotics that kill a wide range of bacteria. This includes not only dangerous bacteria that develop in wounds, but also beneficial gut bacteria.
When healthy gut bacteria are destroyed, any remaining Clostridium difficile multiply out of control in the intestine without other competing bacteria to keep them in check. The bacteria then produce toxins that damage the cells lining the intestines - this in turn causes the symptoms of diarrhoea and colitis. The toxins are known as enterotoxin (toxin A) and cytotoxin (toxin B).
How are the bacteria transmitted?
Most cases of Clostridium difficile develop due to cross-infection from another patient, either through patient-to-patient contact, healthcare staff and patient contact, or through contamination in the immediate hospital environment. Infected patients release large numbers of Clostridium difficile spores in their diarrhoea.
Sources of infection are ward toilets, sinks, beds, sluices, bedpans, commodes, washers and other equipment. Clostridium difficile spores are able to survive for a long time, so if a visitor, patient or hospital worker accidentally touches an infected surface, they can accidentally ingest them or pass them onto other patients.
How is Clostridium difficile treated?
Usually, treatment of Clostridium difficile will be with a metronidazole antibiotic first and then with vancomycin, if there is no improvement.
A non-antibiotic treatment for Clostridium difficile is a faecal enema. This treatment uses donated bowel flora (faeces), which have been homogenised and filtered in sterile saline.
Can probiotic drinks can help protect against Clostridium difficile?
Probiotics are live micro-organisms, such as yeast and bacteria, which are believed to restore the balance of bacteria in the gastrointestinal tract. Probiotics are believed to reduce the risk of infection with Clostridium difficile. Clinical evidence supporting the usefulness of probiotics in the treatment of Clostridium difficile is inconclusive, however (2)
What can hospitals do to reduce Clostridium difficile infection?
- Hospitals should isolate identified Clostridium difficile-infected patients
- Doctors should not over-prescribe (where possible) broad spectrum antibiotics, so that the natural protection afforded by other healthy gut bacteria is not destroyed
- Alcohol gel does not destroy the spores of Clostridium difficile, so regular hand washing before and after contact with patients is vital to stop the spread of the bacteria
- Hospitals should routinely test samples of patient faeces to see if bacterial toxins produced by Clostridium difficile are present
- Where cases of Clostridium difficile are identified, hospital areas should be cleaned using chlorine-based disinfectants to kill the spores
- Healthcare workers working with patients should wear protective clothing, such as aprons and gloves when dealing with bedpans and changing bed sheets
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