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In recent years, intestinal bacteria called Clostridium difficile, or “C. diff,” have become an increasing problem. Each year, tens of thousands of people become ill as a result of C. diff. Patients most often become ill when these bacteria overgrow in the intestinal tract after antibiotics have been used for another condition.

“The combination of the types of antibiotics being given, plus the emergence of new strains which are able to produce more toxins, are making this illness more common,” says John Tully, M.D., Chief of Infectious Diseases at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School.

The bacteria are passed in feces and can be spread through direct contact, surfaces and objects. While it is not airborne, C. diff can easily transfer from one individual to another without proper precautions.

Risks
Hospitalized patients are at highest risk for infection. “We also see C. diff in patients who are in nursing homes or other chronic care facilities,” says Dr. Tully. “Occasionally, we see it in otherwise healthy patients coming in from the community.”

Typically, people in good health do not get sick from C. diff. However, if an antibiotic is administered to treat an infection, the drug can destroy some of the normal intestinal bacteria, creating a more ideal environment for C. diff to advance. Once this imbalance occurs, C. diff produces toxins that break down the lining of the intestine, which is what causes the clinical illness.

Since 2000, several outbreaks of a newer strain of C. diff have appeared, producing far more dangerous toxins.

Symptoms
Symptoms of illness from C. diff can vary drastically. In some cases, C. diff causes mild diarrhea, similar to the “nuisance” side effect often seen with antibiotic therapy.

“On the other end of the spectrum, there are people who have extensive intestinal inflammation from the toxin that the bacteria produce,” says Dr. Tully. “This causes fever, chills, abdominal pain, distended abdomen, diarrhea and sometimes death.”

Treatment
If possible, and recommended by a physician, stop taking the original antibiotic. While this may not always be enough, it can help alleviate mild symptoms. Other treatment may include:

• Antibiotics. Although an antibiotic may have originally caused the illness, mentronidazole or vancomycin are antibiotics that keep C. diff from growing and help restore normal bacteria.
• Probiotics. Probiotics are organisms that help rebuild a healthy balance of bacteria in the intestinal tract. Accompanied with antibiotics, these may be of benefit in some cases.
• Surgery. Surgery to remove the diseased portion of the colon may be the only option in the most severe cases.

Prevention
The following precautions can help prevent C. diff:

• Hand washing. After contact with someone who has C. diff, use soap and warm water to thoroughly cleanse your hands. Alcohol-based sanitizers may not be as effective.
• Contact precautions. Individuals hospitalized with C. diff should be in a private room, and hospital workers who enter that room should wear disposable gloves and gowns.
• Thorough cleaning. All surfaces and equipment should be cleaned thoroughly with a hospital-grade disinfectant or bleach.
• Avoiding unnecessary use of antibiotics. Only take antibiotics when needed. 

“We’ve been especially aggressive to combat this infection with educational programs for medical staff, raising institutional awareness and keeping it high on staff and patients’ radars,” says Dr. Tully.

For a free Mount Auburn Hospital physician directory, please call us at (617) 499-5094.