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Clostridium Difficile Colitis
(Antibiotic-Associated Colitis, C. difficileColitis, C. diff, C diff,)

Medical Author: Dennis Lee, M.D. 
Medical Editor: Jay Marks, M.D.

Symptoms of C. difficileColitis

What Are the Symptoms of C. difficileColitis?

Individuals with mild C. difficile colitis may have:

  • a low-grade fever,
  • mild diarrhea (5-10 watery stools a day),
  • mild abdominal cramps and tenderness.

Those with severe C. difficile colitis may have:

  • a high fever (temperature of 102 F to 104 F),
  • severe diarrhea (more than 10 watery stools a day) with blood, and
  • severe abdominal pain and tenderness.

Severe diarrhea also can lead to dehydration and disturbances in the electrolytes (minerals) in the body. Rarely, severe colitis can lead to life-threatening complications such as megacolon (markedly dilated colon), peritonitis (inflammation of the lining of the abdominal), and perforation of the colon.

What is Clostridium difficile(C. difficile)?

Clostridium difficile (C. difficile) is a bacterium that is related to the bacterium that cause tetanus andbotulism. The C. difficile bacterium has two forms, an active, infectious form that cannot survive in the environment for prolonged periods, and a nonactive, "noninfectious" form, called a spore, that can survive in the environment for prolonged periods. Although spores cannot cause infection directly, when they are ingested they transform into the active, infectious form.

C. difficile spores are found frequently in:

  • hospitals,

  • nursing homes,

  • extended care facilities, and

  • nurseries for newborn infants.

They can be found on:

  • bedpans,

  • furniture,

  • toilet seats,

  • linens,

  • telephones,

  • stethoscopes,

  • fingernails,

  • rings (jewelry),

  • floors,

  • infants' rooms, and

  • diaper pails.

They even can be carried by pets. Thus, these environments are a ready source for infection with C. difficile.

What is Clostridium difficile (C. difficile) colitis?

Antibiotic-associated (C. difficile) colitis is an infection of the colon caused by C. difficile that occurs primarily among individuals who have been using antibiotics. It is the most common infection acquired by patients while they are in the hospital. More than three million C. difficile infections occur in hospitals in the US each year. After a stay of only two days in a hospital, 10% of patients will develop infection with C. difficile. C. difficile also may be acquired outside of hospitals in the community. It is estimated that 20,000 infections with C. difficile occur in the community each year in the U.S.



 

Clostridium difficile

Clostridium difficile (C. difficile) is a bacterium that is present naturally in the gut of around two-thirds of children and 3% of adults.

C. difficile does not cause any problems in healthy people. However, some antibiotics that are used to treat other health conditions can interfere with the balance of 'good' bacteria in the gut. When this happens, C. difficile bacteria can multiply and produce toxins (poisons), which cause illness such as diarrhoea and fever (see Symptoms of C. difficile infection for more information). At this point, a person is said to be infected with C. difficile.

Who is affected?

As C. difficile infections are usually caused by antibiotics, most cases happen in a healthcare environment, such as a hospital or care home.

Older people are most at risk from infection, and most cases occur in people aged over 65 (for more information, see Who is most at risk from C. difficile infection?). Children under the age of two are not usually affected.

How common is it?

In recent years, the number of C. difficile infections has fallen rapidly.

In 2007-08, there were 55,498 cases reported across England. In 2008–09, there were 36,095 reported cases. This is a decrease of 35%.

Prevention

C. difficile bacteria spread very easily. Despite this, C. difficile infections can usually be prevented by practising good hygiene in healthcare environments, such as washing hands regularly and cleaning surfaces using products containing bleach (see Prevention of C. difficile infection for more information).

Outlook

You will only need treatment for a C. difficile infection if you have symptoms. Sometimes, stopping the antibiotics is enough to clear the infection. If symptoms are more severe, you may need to take medication to clear the infection (see Treating C. difficile infection for more information).

Most people with a C. difficile infection make a full recovery. However, in rare cases, the infection can be fatal.

Last reviewed: 17/03/2010

Next review due: 17/03/2012

http://www.nhs.uk/conditions/Clostridium-difficile/Pages/Introduction.aspx 

Quarterly Epidemiological Commentaries on MRSA bacteraemia and C. difficile infection

In addition to the publication of meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile infection (CDI) counts (monthly) and rates (annual) arising from the mandatory surveillance scheme, the HPA produces quarterly epidemiological commentaries.

Aggregated over all English NHS acute Trusts, the commentaries contain a description of the trends in the mandatory reports of these healthcare-associated infections over a period of 9 quarters. The commentaries also describe trends in other epidemiological factors such as the age and sex profiles of patients with the infections and differences in hospital demographics; for example patient provenance and treatment specialities.

In each commentary will be a special feature describing an in depth analysis of some aspect of MRSA bacteraemia and/or C. difficile infection epidemiology.

The commentary is produced as a single report combining both organisms and is available as a PDF. This series began in December 2009.

Current report:

March 2010: Quarterly epidemiological commentary (PDF, 890 KB): Trends in MRSA bacteraemia and C. difficile infection from October 2007 to December 2009. Special features: a) Causes of MRSA bacteraemia and b) Repeat episodes of Clostridium difficile.

Next publication date: 18th June 2010 (January-March 2007 to January-March 2009 data).

Previous report:

December 2009: Quarterly epidemiological commentary (PDF, 317 KB): Trends in MRSA bacteraemia and C. difficile infection from July 2007 to September 2009.

http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1259151891722

 

C. difficile infections surpass MRSA in community hospitals

2010, March 25, 4:13 PMInfectious Disease ExaminerRobert Herriman
Comment Subscribe
New data shows C. difficile passing MRSA in hospitals
New data shows C. difficile passing MRSA in hospitals
abc.net.au
This is according to research presented at the 5th Decennial International Conference on Healthcare-Associated Infections by Dr. Becky Miller and her team at the Duke Infection Control Outreach Network (DICON).

The Duke team had looked at data from 28 hospitals in the network, located in Georgia, North Carolina, South Carolina and Virginia. DICON is a collaboration between Duke and 39 community hospitals that work together on infection control issues.

What they found was during a 2 year period, the number of C.difficile infections in the 28 participating hospitals was 25 percent higher than the rate of infection due to Methicillin-Resistant Staphylococcus aureus (MRSA).

According to Dr. Miller, “We found that MRSA infections have declined steadily since 2005, but C. difficile infections have increased since 2007”.

What is C. difficile?

Clostridium difficile is a bacterium found throughout nature; soil, water and the intestines of humans and various animals. It has been isolated in the feces of 3% of healthy adults according to one study. It is however more prevalent in hospitalized adults with colonization rates of up to 30 percent seen.

It is implicated as a causative bacterium of antibiotic-associated diarrhea (AAD) and pseudomembranous colitis (PMC). The problem is when there is a decrease of normal intestinal flora typically due to the use of antibiotics (the list of antibiotics is quite long). This allows the C. difficile that is normally in check, to flourish and produce some potent toxins that results in diarrhea or the potentially life-threatening PMC.

C. difficile is laboratory diagnosed by detection of the toxin(s) in feces. Vancomycin is the treatment of choice for C. difficile disease, though relapses are common.

It is suspected by infection control experts that the common use of alcohol hand cleansers which are effective against MRSA, are likely ineffective against the spore-forming C. difficile, making it easier to spread throughout a hospital environment.

Hospitals will likely use the same attention and vigor they used in preventing MRSA and do the same for C. difficile.

http://www.examiner.com/x-7707-Infectious-Disease-Examiner~y2010m3d25-C-difficile-infections-surpass-MRSA-in-community-hospitals

Uusittu artikkeli/ An updated article:

http://en.wikipedia.org/wiki/Clostridium_difficile

What is Clostridium difficile (C.diff)?

Clostridium difficile is a member of a large group of bacteria, the clostridia, that grow in the absence of oxygen and are able to form heat-resistant spores.

C.diff is a very tough bug that lives in people's intestines. It is common in young children and in people over the age of 75.

When does it occur?

It becomes a problem when a person's normal gut flora is disturbed, for example during antibiotic treatment. As well as doing its job to get rid of harmful bugs in the body, antibiotics also zap away the "friendly bacteria".

Why is C.diff such a problem?

There are very few antibiotics that are effective against C.diff and relapses are common after antibiotic treatment. Without the aid of "friendly bacteria", the C.diff grows and produces poison.

How does it spread?

C.diff is very clever in that it makes spores which are very tough. They can last in the environment for years.

Spores can be spread in the wind, but C.diff's most efficient means of transport are the hands.

It is very easy for the bug to get on the hands and once the hands touch the mouth, it is then very easy for it to travel to the gut.

What is it resistant to?

The bug can withstand heat. It can survive disinfectant and it does not mind alcohol.

What are the symptoms of C.diff?

Symptoms of the bug include mild to severe diarrhoea, blood-stained stools, fever and abdominal cramps.

These symptoms are usually caused by an inflammation of the lining of the large intestine. In rare cases, C.diff can cause peritonitis, an infection of the lining in the abdomen, blood poisoning and tears in the large intestine.

In very rare cases, a C.diff infection can be fatal. The risk of this is higher in elderly people and people who have other very serious health conditions.

Who is Professor Hugh Pennington?

Hugh Pennington is an emeritus professor of bacteriology at the University of Aberdeen.
 
Professor Hugh Pennington
Professor Hugh Penningto

He chaired a Scottish Executive established expert group following the E.coli O157 outbreak in central Scotland in 1996.

Prof Pennington also headed a public inquiry into the 2005 E.coli outbreak in Wales in which a five-year-old boy died.
He has also been credited with having made a significant contribution to the science and practice of medical microbiology, to the health of the nation and to public understanding of science.

http://news.bbc.co.uk/2/hi/uk_news/scotland/7710731.stm