What is Clostridium difficile?
Many different bacteria (germs) live in the normal healthy bowel. Clostridium difficile (also known as C. diff) is a bacterium that can be present in the bowel of up to three percent of healthy adults. It does not usually cause any harm but if the number of the bacteria increases, in certain individuals, it can cause C. difficile infection and diarrhea.
How do you get Clostridium difficile related diarrhoea?
Clostridium difficile infection is most often linked with people taking antibiotics and laxatives. It can also be acquired from the environment and contact with other people who carry the C. difficle infection.
When you take medications such as antibiotics or laxatives the normal (healthy) bacteria in the bowel can be reduced which allows the C. difficile to rapidly multiply and increase in number. This can cause diarrhoea.
Patients particularly at risk of getting Clostridium difficile are:
- People taking or who have recently finished a course of antibiotics or laxative medication which can alter the normal bacteria of the bowel
- People who have had abdominal surgery
- People with underlying medical conditions
- People who are over 65 years of age
What are the symptoms?
Symptoms range from mild stomach pain and mild and infrequent looser than normal stools to severe stomach pain potentially with explosive, watery, and smelly diarrhoea. This can last for several days and sometimes weeks. Occasionally patients develop a severe form of the disease that causes inflammation of the bowel known as colitis.
How do I know if I have Clostridium difficile infection?
Diagnosis is based on a combination of the clinical picture (your symptoms, observations, and examination findings), findings from investigations such as abdominal x-rays and scans and laboratory testing on a sample of your diarrhoea. All C. difficile infection cases are discussed between the team on the wards and an infection specialist.
Your doctor or nurse will discuss the result with you.
This trust performs a three-part test in the laboratory to look for Clostridium difficile.
GDH is the first part of the test. GDH stands for glutamate dehydrogenase which is an enzyme (enzymes speed up chemical reactions in the body) that can be found in the C. difficile bacteria. If the GDH test is positive the second stage of the test is performed to look for C. difficle toxins.
If this second stage is positive, it means you have C. difficle infection.
If the toxin test is negative, it means you do not currently have C. difficile infection. However, the third test is then carried out which is a molecular test which looks for the DNA of C. difficile. This is called a polymerase chain reaction test referred to as PCR.
When the PCR is positive it suggests that you carry C. difficile in your bowel which has the potential to produce the toxins associated with C. difficile infection.
A clinical assessment is then made to determine if you require treatment for C. difficile diarrhoeal infection.
How will I be treated?
It is important that the staff caring for you know when you have had diarrhoea. If your diarrhoea is not getting better, your doctor may change any medications you currently take that are associated with C.difficile or stop them.
The decision to treat you will be made by your doctor. In some cases, no specific treatment is required.
There are three types of antibiotics that can be used to treat C. difficile infection currently – Vancomycin, Metronidazole and Fidaxomicin.
How will I be looked after?
In hospital you will be cared for in a single room with a designated toilet or commode while you have diarrhoea. This is because of the risk of passing the infection to other patients.
C. difficile may be spread on people’s hands and health care workers caring for you will wash their hands with soap and water.
They will also wear long sleeved gowns and gloves to protect you and other patients.
C. difficile spores are difficult to remove from the environment and special cleaning measures will be carried out.
Can my visitors catch Clostridium difficile?
Healthy people rarely develop C. difficile diarrhoea. The greatest risk is to those who are frail or unwell. It is very important that all visitors wash their hands thoroughly with soap and water when they leave your single room and when entering and leaving the ward. Alcohol based hand sanitisers are not effective against C. difficile spores.
It is not normally necessary for visitors to wear long sleeved gowns or gloves. However, if visitors have close contact with a patient (such as help with washing, dressing, and feeding), aprons and gloves should be worn for those episodes of care, removed and then they should wash their hands.
For infection prevention and control purposes visitors are requested not to visit if they are unwell themselves or a member of their family is unwell with symptoms of diarrhoea or vomiting. This helps to control the spread of further infection.
What can I do to help my recovery?
It is important that you clean your hands with soap and water
- Before you eat
- Before you drink
- After you have been to the toilet
It is very important to maintain good personal hygiene.
Make sure any sweets, biscuits, or fruit you have is kept in your locker or is in a closed container. It will help if you drink lots of fluids to avoid becoming dehydrated while you have diarrhoea.
This helps to control the spread of further infection.
What happens when I stop having diarrhoea?
Once your diarrhoea has stopped for a period of three days and if you pass formed stools, it may be possible for you to move out of the single room back to the main ward. Your doctor or nurse will let you know when this is possible.
What happens in the future?
In most cases the symptoms of diarrhoea resolve within a few days or weeks.
Sometimes the diarrhoea can start again. If you develop any further diarrhoea during your hospital stay you must inform the nurse looking after you immediately.
Once you are discharged home, please contact your GP if you develop further symptoms of diarrhoea.
It is difficult to know exactly what the cause of the relapse of diarrhoea is; it can sometimes be as a result of the same infection or another reason.
As antibiotics and laxative medications increase the risk of a relapse of C. difficile, it is important that you inform your doctor about your history of GDH or C. difficile before starting such treatment in the future
Recurrent CDI infection
Around 1 in 4 people who get C.difficile infection will get CDI again.
A further episode of CDI within 12 weeks of symptom resolution is called a ‘relapse’ of CDI.
A further episode more than 12 weeks after symptom resolution is called a ‘recurrence’.
The risk of recurrence increases with every subsequent infection.
Recurrent infection may be caused by the same strain of bacteria as your previous infection or by reinfection with a different strain.
Recurrent infection can be associated with a contaminated environment, poor hand washing or from the CDI spores in the bowelbecoming active again. The most common cause of recurrent CDI is further antibiotic use so antibiotics should only be used if absolutely necessary.
Treatment options
Further treatment options available to you include
- A course of medication called Fidaxomicin which is taken twice a day for 10 days
- A longer (+/- higher dose) course of medication called Vancomycin
- Faecal Microbial Transplantation (FMT). This is recommended if you have had 2 or more episodes of recurrent CDI as it has been shown to greatly reduce the risk of further recurrent CDI compared to Vancomycin and / or Fidaxomycin.
Please refer to leaflet on FMT for further information and discuss with your healthcare provider. Additional advice and support are available from the Infection Prevention & Control team. If you need to speak to someone, please call 0191 4458434 or 0191 4458435.