1 Answer

What is Clostridium difficile?

Clostridium difficile is a spore-forming bacterium which is present as one of the 'normal' bacteria in the intestine. As many as two thirds of infants and 3% of adults have Clostridium difficile in their gut, where it rarely causes problems.

How can Clostridium difficile make you unwell?

Clostridium difficile can cause illness when certain antibiotics disturb the balance of 'normal' bacteria in the gut. When a person is healthy and NOT taking antibiotics, the millions of 'good' bacteria in the intestine keep the Clostridium difficile under control and in small numbers. However, when antibiotics are taken, the levels of 'good' bacteria are reduces and it is possible that the Clostridium difficile will grow in greater numbers inside the intestine. When this happens an illness called Clostridium difficile colitis may develop.

What is Clostridium colitis?

Clostridium difficile bacteria producer toxins which cause inflammation of the intestinal lining. This may lead to diarrhoea and cramping at first, and in later stages, flu-like symptoms, nausea, vomiting and blood in the stool/faeces. Most cases of Clostridium difficile colitis make a good recovery, although occasionally the colitis may cause significant damage to the intestinal mucosa and very rarely this may lead to perforation of the bowel, peritonitis and death.

Are some people more at risk?

More than 80% of cases are reported in the over 65 age group. Immunocompromised people are also at increased risk. Abdominal surgery, antibiotic exposure, long length stay in healthcare settings, serious underlying illness and advanced age are all factors which will increase the risk of a person developing Clostridium difficile.

How is Clostridium difficile colitis diagnosed?

The disease may be suspected if a person has been taking, or is currently taking, antibiotics and is suffering with abdominal cramps and diarrhoea. A diagnosis is made by a laboratory test using a stool sample to confirm whether or not the toxin is present in the intestine. The results are usually available within 24 hours. A person may have Clostridium difficile in their stool but without the symptoms of diarrhoea - it is unlikely that they would have Clostridium difficile colitis.

Is it catching?

Although some people can be healthy carriers of Clostridium difficile, in most cases the disease develops after cross-infection from another patient, either through direct patient-to-patient contact, via healthcare staff, or via a contaminated environment. A patient who has Clostridium difficile diarrhoea excretes large numbers of the spores in liquid faeces. These can contaminate the general environment including surfaces, keypads and equipment, the toilet areas, sluices, commodes, bed pan washers, etc. They can survive for a long time and be a source of hand-to-mouth infection for others. If these others have been given antibiotics, they are at risk of developing Clostridium difficile colitis.

To avoid spread, strict hygiene is essential. Hand washing using soap and water is of the utmost importance. Healthcare staff should wash their hands before and after every patient contact, and patients should be encouraged to wash their hands before eating and after using the toilet, commode or bedpan.

The environment should be kept dust-free and be regularly cleaned with detergents. A chlorine-releasing disinfectant should be used after cleaning any faecal spillage.

If a person is in hospital they will probably be nursed in a single room with their own commode and en-suite facilities. The staff caring for a person with diarrhoea will wear apron and gloves in these settings.

How is Clostridium difficile treated?

Clostridium difficile colitis may be treated with specific oral antibiotics, which must be taken as prescribed. It is important that the whole course of antibiotic treatment is completed even if the symptoms (diarrhoea and abdominal cramps) resolve meanwhile. Cessation of diarrhoea and/or a formed stool indicate that the infection has passed. No further stool testing is required.

It is also important to ensure that the person does not become dehydrated as the diarrhoea continues.

If a person has had Clostridium difficile colitis when in hospital, will they need special care in the community?

No. The symptoms of diarrhoea should have stopped (or a formed stool passed) 48hrs before discharge, but a patient may still be on antibiotics. The normal procedures of hand washing, appropriate use of gloves and aprons by care staff and a clean environment are all that is needed.

If diarrhoea should recur, the GP should be informed and a stool sample obtained to exclude the possibility of another cause of symptoms. Hospital admission is not necessary as long as the patient remains hydrated and the diarrhoea begins to resolve once appropriate antibiotics are commenced.

Can anything be done to prevent colitis from developing?

Some studies have identified that giving pro-biotic preparations containing 'good' bacteria may have a preventative effect if a person is prescribed antibiotics.

NHS.org