Clostridium difficile (commonly known as C. Diff) is one of the most common hospital-acquired gastrointestinal infections. Though relatively rare compared to other intestinal bacteria, C. diff is one of the most important causes of infectious diarrhea in the U.S.

The incidence of C. diff is rising rapidly with increased use of antibiotics. There are approximately 30,000 deaths related to the disease every year in the United States. This is compared to Salmonella with only 300 deaths per year. The rate of C. difficile infections has doubled over the last 20 years with nearly ½ million cases per year. Relapse is very common with 20% recurrent disease after initial treatment and an even higher chance of recurrence after one episode of relapse.

Symptoms of C. Diff

C. difficile infection can range from mild to life threatening. Symptoms of mild cases include watery diarrhea, three or more times a day for several days, with abdominal pain or tenderness.

Symptoms of more severe C. diff infection include:

• Watery diarrhea, up to 15 times each day
• Severe abdominal pain
• Loss of appetite
• Fever
• Blood or pus in the stool
• Weight loss

Risk factors for developing C. Difficile infection

Infection usually requires two steps: exposure to the bugs or spores and use of antibiotics. Certainly not all of the cases require antibiotics but antibiotics are major risk factors. Clostridium difficile bacteria are not very good at competing for growth within a healthy colon with a full complement of bacteria. There are over 1,000 species of bacteria in the colon and some of these bacteria are very good at suppressing the growth of C. difficile. When the healthy bacteria are killed with the use of antibiotics the C. difficile multiply and begin to produce a toxin that causes diarrhea and colitis.

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Use of acid suppression medications is also a risk factor. C. difficile is spread through the fecal oral route. Medications that suppress the acid in the stomach may make it more likely for C. difficile to make it through the stomach without being destroyed by acid. People older than 60 years old are more likely to develop this infection as well as patients with other health problems such as Crohn’s disease or ulcerative colitis.   

What to Do if the Infection Comes Back

Immediate recurrence when we stop antibiotic use is seen in approximately 20% of patients. Despite this, retreatment with antibiotics is often effective. After antibiotics are completed, it’s a race to see which comes back first–the healthy bacteria within the colon or the C. difficile. There are several antibiotics used to treat C. difficile recurrence but these alternative antibiotics tend to be very expensive. After three failed attempts at treatment of C. difficile, a fecal transplant is recommended.

What is a Fecal Transplant?

A fecal transplant is a way to restore all of the patient’s healthy colon flora during one procedure. First we identify a healthy person to donate stool. Previously this was often a friend or family member. The donor is tested for common communicable diseases including hepatitis and HIV as well as some other viral and bacterial infections.

After the stool is determined to be safe it is processed into a liquid. We then deliver the stool into the colon either during a colonoscopy or through a nasojejunal tube. There is a company now that screens stool donors and sells product to hospitals, taking some of the pressure off the patient find their own donor.

Ways to Minimize Your Risk

• Handwashing is very important. Keep in mind that alcohol sanitizers don’t kill C diff. bacteria.
• Proper antibiotic use is key. Make sure antibiotics are necessary and that the correct narrow spectrum antibiotic is used.
• Minimize exposure to known infected individuals.
• Probiotics may help if antibiotics are needed.