Biology and Genetics Issues
Clostridium Difficile infection

Background

Clostridium difficile (CD) bacteria are an important cause of infectious disease deaths in the United States and around the world. These bacteria represent the most common cause of diarrhea among hospitalized persons in Canada, United States and other developed countries. It is first identified in the 1930s and it was recognized as a cause of human illness in 1978. It is naturally found in air, water, on many surfaces, in soil and in the intestine of humans and animals. While being outside the body, they exist in the form of spores, which protect them from any destructive substances including chemicals. They are transmitted to our body through contact of hands contaminated with the spores with the mouth, foods or drinks. Clostridium difficile comprise a small proportion of the intestinal bacteria. They cannot grow freely due to competition with the other non-harmful bacteria on food resources. When these non-harmful bacteria are killed by antibiotics, clostridium difficile starts growing up, producing its toxins and causing diarrhea. The symptoms range from none (carriers of the bacteria) to mild or moderate diarrhea with abdominal pain and fever, to the more severe form, which might require surgical intervention (removing the colon), or lead to death.

Health Risk:

Normally, people in good health do not get C. difficile infection. Those at higher risk include the elderly, hospitalized, and immune-compromised persons and those on long-term or multiple treatment with antibiotics. A Canadian report showed that the Clostridium difficile infection rate is 3.43 cases per 1000 adult patients. Recently, the incidence of CD infections has changed in terms of the type of at-risk population and in terms of happening outside the hospital environment (community-associated CD infections). A United States study reported an increase in the incidence of CD infections among children with a rate of 1.28 cases per 1000 patient. Another US study showed an increase of the incidence rate among pregnant women from 0.04 to 0.07 cases per 1000 discharged ladies. The approximate rate was between 20%-27% of the total CD infected cases. In a study published in 2016, the total cost of managing CD infections in the United States (including hospitalization, diagnosis and treatment) was estimated at $6.3 billion per year.

Management:

The are two major options for managing CD infections, which include the treatment of existing cases and the prevention of future infections. Treatment involves providing sufficient fluids and nourishment, symptomatic relief of fever and pain, and the appropriate use of antibiotics. Many studies reported antibiotics as the most reversible cause of CD infections. Antibiotic prescribing should be conducted according to the approved treatment guidelines. Healthcare staff should be constantly reminded with the importance of following these guidelines. Hand hygiene and the use of personal protective tools must be encouraged while serving hospitalized patients and not just CD infected patients to minimize the risk of transmission of CD infections. Such preventive practices must be heavily promoted across all environments such as schools and work places to further reduce such a risk.

Useful Links

Centers for Disease Control and Prevention, USA
Clostridium difficile Infection.
http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html.

Public Health Agency of Canada
Infectious Disease—The Never-ending Threat [The Chief Public Health Officer’s Report on the State of Public Health in Canada, 2013]
http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2013/infections-eng.php

Infection Prevention and Control Guidance for Management in Long-term Care Facilities - Clostridium Difficile Infection
http://www.phac-aspc.gc.ca/nois-sinp/guide/c-dif-ltc-sld/index-eng

Mayo Clinic
Overview, Clostridium difficile infection [Mayo Clinic]
http://www.mayoclinic.org/diseases-conditions/c-difficile/home/ovc-20202264

Symptoms and causes, Clostridium difficile infection [Mayo Clinic]
http://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/dxc-20202389 Diagnosis and management, Clostridium difficile infection
http://www.mayoclinic.org/diseases-conditions/c-difficile/diagnosis-treatment/diagnosis/dxc-20202420

Further Reading

Canadian Antimicrobial Resistance Surveillance System Report 2016:
http://healthycanadians.gc.ca/publications/drugs-products-medicaments--produits/antibiotic-resistance-antibiotique/antimicrobial-surveillance-antimicrobioresistance-eng.php#a4-2-1

Current Status of Clostridium Difficile Infection Epidemiology:
http://cid.oxfordjournals.org/content/55/suppl_2/S65.full

Burden of Clostridium difficile Infection in the United States:
http://www.nejm.org/doi/full/10.1056/NEJMoa1408913#t=article

Strategies to prevent Clostridium difficile infections in acute care hospitals:
https://pdfs.semanticscholar.org/b641/2a9da7fae9922bcee6bb8a6e1016134c4fed.pdf

Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA):
http://www.cdc.gov/HAI/pdfs/cdiff/Cohen-IDSA-SHEA-CDI- guidelines-2010.pdf

The pathogenicity of Clostridium difficile:
http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)62686-0/fulltext

Contributor: Louay Al Shamma

Last reviewed: November 6, 2017