Clostridium difficile, also known as C. difficile or C. diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. C. difficile infection most commonly affects older adults in hospitals or long-term care facilities and typically develops from the use of broad-spectrum antibiotics. When antibiotics destroy normal gut bacteria, C. difficile is given an opportunity to flourish and produce toxins that cause illness. Prompt diagnosis and proper treatment is important to resolve symptoms and prevent recurrence.
Diagnosing C. Difficile Infection
The first step in diagnosing a C. difficile infection is for a healthcare provider to suspect it based on symptoms and risk factors. Diarrhea is the main symptom but abdominal pain, fever, and loss of appetite may also occur. Anyone who has recently taken antibiotics or has risk factors like advanced age or underlying health conditions may warrant testing.
Stool Testing
The main diagnostic tests are ones that detect C. Difficile toxins or genetic material in stool samples. A toxin enzyme immunoassay or toxin A/B tissue culture tests look for toxins produced by C. difficile. A nucleic acid amplification test checks stool for genetic sequences specific to C. difficile. At least three diarrhea samples over several days may need to be tested to rule out or confirm infection. Repeat testing is often needed if the first test is negative but C. difficile is still suspected.
Endoscopy
In more severe or complicated cases, a healthcare provider may perform a sigmoidoscopy or colonoscopy to directly visualize the colon for signs of inflammation. During these procedures, a biopsy of the colon lining can also be taken and analyzed under a microscope to check for certain changes consistent with a C. difficile infection.
Treating C. Difficile Infection
Treatment involves antibiotics targeted at C. difficile as well as supportive care measures. The main antibiotic options are metronidazole, vancomycin, and fidaxomicin. Choice of treatment depends on factors like infection severity and if it is a first episode or recurrence.
Oral Antibiotics
For mild to moderate initial infections, metronidazole is usually the first choice due to its low cost and ability to reach the colon. A typical course is 500mg three times daily for 10 days. For severe infections affecting other parts of the intestine or multiple recurrences, vancomycin taken four times daily for 10 to 14 days is preferred. The antibiotic fidaxomicin may also be considered as it has a lower recurrence rate than vancomycin.
Discontinuation of Unnecessary Antibiotics
It is important that people with C. difficile stop taking any antibiotics not needed to treat the infection. Unnecessary use supports the growth of C. difficile and makes treatment much more difficult. Broad-spectrum antibiotics are especially problematic in perpetuating C. difficile.
Diet and Hydration
Getting plenty of fluids and eating a bland, nutrition-filled diet helps replace lost electrolytes and nutrients during bouts of diarrhea. Recommendations include clear soups, yogurt, bananas, rice, applesauce and hydrating drinks. Fiber-containing foods are temporarily avoided as not to stimulate the intestines.
