Clostridium Difficile Infection

GENERAL INFORMATION:

What is a Clostridium difficile infection?

• A Clostridium (klo-STRID-ee-um) difficile (DIFF-i-sile) infection is also known as Clostridium difficile-associated diarrhea. It occurs when bacteria (germs), called Clostridium difficile or C. difficile, affect the colon (large bowel). Normally, different bacteria live inside the colon and do not harm the body. There is a balance between good and helpful bacteria and bad bacteria, such as C. difficile. A clostridium difficile infection happens when this healthy balance changes. This may give C. difficile a chance to multiply (increase in number) and cause an infection.
  
  
• The colon is the long tube that connects the small bowel with the anus (rear end). The colon absorbs water from digested foods and turns the digested food into stool. It stores the stool until it can be passed out through your anus. When there is a change in the balance of the colon's bacteria, C. difficile is able to enter the colon. It then releases chemicals that inflame (swell) the lining of the colon. A Clostridium difficile infection usually occurs in hospitals, nursing homes, and long-term care centers. It is also the most common cause of pseudomembranous colitis (swelling of the colon).

How does a Clostridium difficile infection spread? The stool (bowel movement) of a person with a Clostridium difficile infection contains C. difficile bacteria. Infected people, who do not wash their hands after having a bowel movement, may spread the bacteria. The bacteria may be passed from one person to another by simply touching a contaminated (dirty) hand. The germ enters the body when the contaminated hand is put in the mouth. Clostridium difficile may also be found on the surfaces of bed rails, floors, windowsills, or toilet handles. Drinking water or eating food that has been exposed to C. difficile may also spread the infection.

What increases the risk of getting a Clostridium difficile infection? The following may increase your risk of getting a C. difficile infection:

• Age: In the elderly, the body changes and certain diseases can more easily affect you. Newborn babies also have an increased risk of being infected.
  
  
• Antacids: These medicines decrease the stomach acid that can kill harmful bacteria.
  
  
• Antibiotics: Antibiotics are medicines that kill bacteria, including the good ones. Taking them often may upset the balance between the good and bad bacteria in the colon.
  
  
• Dormant infection: The C. difficile bacteria, from a previous infection, may still be in your system and may cause another infection.
  
  
• Hospital stay: Staying in the hospital too long or sharing a room with a C. difficile infected patient increases your risk.
  
  
• Nasogastric tube: This tube is also called an NG tube or NGT. It is put into your nose and down your stomach to feed you or keep your stomach empty. Having an NGT may promote a C. difficile infection.
  
  
• Weak immune system: The immune (body defense) system is the part of your body that fights infection. Chemotherapy and other medicines, such as steroids, decrease your immune system and make it weak. Having surgeries or procedures, such as an organ transplant, in the past may also affect your body defenses.

What are the signs and symptoms of a Clostridium difficile infection? Diarrhea (loose, watery stools) caused by C. difficile infection may begin while you are taking antibiotics. Diarrhea may also happen up to six weeks after you have stopped taking the antibiotics. Blood, mucous, or pus may be present in your stools. You may have bad-smelling diarrhea 20 to 30 times each day. You may also have one or more of the following:

• Fever or crampy pain in the abdomen (stomach)
  
  
• Nausea (upset stomach) or vomiting (throwing up).
  
  
• Dehydration (lose too much body fluid).

How is a Clostridium difficile infection diagnosed? You may have one or more of the following tests:

• Blood tests: Many different tests will be done with your blood, such as a test to see if you have an infection.
  
  
• Imaging tests:
  
  
  • Colonoscopy: A colonoscopy is a test that is done to look at your colon. A tube with a light on the end will be put into your anus, and then moved forward into your colon.
    
    
  • Computerized tomography scan: This test is also called a CT or CAT scan. An x-ray machine uses a computer to take pictures of your abdomen, such as small and large bowels. Before taking the pictures, you may be given a dye through a small tube placed in your vein (IV). The dye helps the colon show up better in the pictures. People who are allergic to shellfish (lobster, crab, or shrimp) may be allergic to this dye. Tell your caregiver if you are allergic to any of these.
    
    
  • Endoscopy: This test uses a scope to see the inside of your digestive tract. A scope is a long, bendable tube with a light on the end of it. A camera may be hooked to the scope to take pictures. During an endoscopy, caregivers may find problems with how your digestive tract is working. Samples may be taken from your digestive tract and sent to a lab for tests. Small tumors may be removed, and bleeding may be treated during an endoscopy.
    
    
  • Sigmoidoscopy: A sigmoidoscopy test looks for changes in your intestinal (bowel) wall that may be caused by a disease or condition. This test may also help find the cause of bleeding or pain. A long, thin tube with a tiny camera on the end is put through your anus into your rectum (rear-end). It also goes to the part of your intestine called the sigmoid. Caregivers will look for problems in your rectum and lower colon. A small amount of tissue may be taken from the intestine wall and sent for tests. Follow your caregiver's instructions for what to do before, during and after the test.
    
    
  • Abdominal x-rays: Abdominal x-rays are pictures of the organs inside your abdomen. Caregivers use these pictures to look for problems such as blocked or ruptured intestines, kidney stones, or solid masses (tumors) in your organs.
  
  
• Stool exam: A sample of your stool is sent to a lab for testing. These stool tests may show what kind of C. difficile bacteria is causing your illness. This helps caregivers know what treatment is best for you.

How is a Clostridium difficile infection treated? The treatment for C. difficile infection aims to replace lost fluids and prevent dehydration. Caregivers may need to stop or change the antibiotic you are currently taking. Anti-diarrheal medicines or opiates are not advised because they may make the infection last longer. You may have one or more of the following:

• Medicines:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Immune globulins: Immune globulins can be used to treat many different problems. It may be given to help your immune system fight infection. It may also help if your body does not produce enough of certain kinds of blood cells. This medicine may help if your system fights something in your blood or body that it should not. Ask your caregiver for more information about how immune globulin medicine may help you.
  
  
• Supportive therapy:
  
  
  • Oral rehydration therapy: This therapy is to replace lost body fluids by drinking plenty of liquids to avoid dehydration. You may also drink an oral rehydration solution (ORS). An ORS has the right amounts of water, salts, and sugar you need to replace body fluids.
    
    
  • Intravenous therapy: If you are dehydrated, you may have to stay in the hospital and receive intravenous (IV) fluid. An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
    
    
  • Probiotics: These are supplements that contain good bacteria that is normally found in a person's colon.
  
  
• Surgery: Caregivers may need to do a colectomy if your C. difficile is very bad. This surgery removes the affected part of your colon. This may also be done if there are holes or leaks in your colon.

How can a Clostridium difficile infection be prevented?

• Discard used disposable diapers in a sealed plastic bag.
  
  
• Drink only well-sealed bottled or carbonated water. Boil drinking water coming from the faucet for 10 minutes.
  
  
• Limit the use of antibiotics. Ask your caregiver for more information about the proper use of antibiotics.
  
  
• Place wet and soiled laundry, including cloth diapers, in a plastic bag and use detergents (soap) when washing it.
  
  
• Use alcohol or chlorine-based disinfectants (germ killers) when cleaning surfaces. Wear gloves, a mask, or a gown to protect yourself.
  
  
• Wash hands often with soap and warm water. Always wash after using the toilet, after diapering a child, and before preparing or serving food. Germ-killing hand lotion or gel may be used to clean hands when there is no water available.

Where can I find more information? Having a Clostridium difficile infection may be hard. Contact the following for more information:

• Centers for Disease Control and Prevention
  National Center for Infectious Diseases
  Phone: 1-888-4437232
  Web Address: http://www.cdc.gov/ncidod/
  

• National Digestive Diseases Information Clearinghouse (NDDIC)
  2 Information Way
  Bethesda, MD 20892-3570
  Phone: 1-800-8915389
  Web Address: www.digestive.niddk.nih.gov
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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