Clostridium Difficile

Written by: Marwah Saeed, BSc (Hons), MBBS

Updated: March 6th, 2023

Have you heard of Clostridioides difficile? It is a leading cause of infectious diarrhea in hospitals and long-term care facilities in Canada (Pereira et al., 2020). Since the 2000s, there has been a dramatic increase in the number and severity of Clostridioides difficile infection cases across the globe (American College of Gastroenterology, 2021); according to research approximately 41% of these infections are acquired in the community (Mada & Alam, 2022).

So, what is Clostridioides difficile?

Clostridioides difficile, more commonly known as C. diff for short, is a type of bacteria that causes irritation and swelling of the colon (colitis) leading to gastrointestinal issues such as nausea, vomiting, abdominal pain and diarrhea (HealthLink BC, n.d).

C. diff lives in the intestines of 1-3% of people (HealthLink BC, n.d). In fact, it is considered a part of the natural gut flora, which means that it lives harmlessly in the large bowel along with other types of “good” bacteria. These bacteria function to keep the bowel healthy. However, if the natural balance of the gut bacteria is altered, C. diff can flourish and release toxins (poisons). This damages the intestine causing diarrhea and other health problems (HealthLink BC, n.d.; American College of Gastroenterology, 2021).

**How is C. diff transmitted?**

C. diff is transmitted through the fecal-oral route. It is found in feces of infected individuals and transfers through contact with contaminated hands or surfaces. It is also contagious, spreading from person to person. Furthermore, it can persist on surfaces for a long time as inactivated or dormant spores (Centers for Disease Control and Prevention [CDC], 2021).

What puts you at risk of C. diff infection?

C. diff can affect anyone, but most cases are associated with certain high-risks antibiotics such as clindamycin, quinolones and cephalosporins (American College of Gastroenterology, 2021). When used in high doses or for a prolonged period, they can alter the normal levels of the bacteria giving C. diff an opportunity to thrive (Public Health Agency of Canada, 2014).

Other factors that can put you at risk include:

Medicines that reduce stomach acid, such as Nexium, Prevacid, or Losec
Advanced age (65 and older)
Weakened immune systems ex. people living with HIV/AIDS, cancer or organ transplant
Pre-existing bowel conditions such as Inflammatory Bowel Disease (IBD)
Staying in a hospital or long-term care facilities
Previous C. diff infection (American College of Gastroenterology, 2021, familydoctor.org, 2020)

What are the symptoms of C. diff?

Diarrhea is the most commonly reported symptom of C. diff. However, symptoms can range from mild to severe. Mild symptoms include 3 or more daily episodes of diarrhea for a few days and belly pain/tenderness. Severe symptoms can range from watery diarrhea with mucus or blood to fever, nausea, vomiting, belly cramps, bloating, loss of appetite and dehydration. Sometimes it can even progress to life-threatening colon inflammation (American College of Gastroenterology, 2021; familydoctor.org, 2020).

What happens if I have symptoms?

Speak to your doctor. If C. diff infection is suspected, a stool test may be ordered. Treatment depends on the severity of symptoms. If the test is positive, your doctor will prescribe an appropriate antibiotic to treat the infection. Your doctor may also recommend stopping the antibiotic that led to the infection in the first place. However, this may not always be possible as some individuals require long-term antibiotics for underlying health conditions. Depending on the severity of symptoms, you may also need to be hospitalized. Sometimes complications may arise such as toxic megacolon, a condition in which the large bowel is dilated and at risk of perforation. In such cases, surgery might be considered to remove the affected portion of the intestine (American College of Gastroenterology, 2021; HealthLink BC, n.d.). By working together with your doctor, you can determine what the next steps, best suited, for you are.

Are there any steps I can take to prevent CDI?

There are several things you can do to prevent yourself from developing or spreading a C. diff infection.

These include strategies such a:

Be cautious about hygiene. Wash your hands regularly with soap and warm water for at least 20 seconds. Remember Clostridium Difficile is contagious.
Don’t take antibiotics unnecessarily. When you take antibiotics, the “good” bacteria in your intestines can also be killed, which may cause C. diff to grow out of control. Limit the use of antibiotics to bacterial infections, as prescribed by your doctor.
Keep high-use surfaces or areas clean. Periodically clean these areas, especially the kitchen and bathroom. C. diff spores are hardy; be sure to use products containing chlorine bleach because it is an effective disinfectant against C. diff (familydoctor.org, 2020).

Another way is through the use of probiotics.

The World Health Organization (WHO) defines probiotics as “live microorganisms which when administered in adequate amounts confer a health benefit on the host (Hill et al., 2014). In simple terms, probiotics are “good bugs” or “good microbes” that improve certain aspects of our health. They are available as dietary supplements and can also be found in foods such as certain kinds of yogurt.

It’s important that you talk with a health care professional – your doctor, pharmacist, or dietitian – first before taking a probiotic supplement, to ensure you have a proper diagnosis or know why you are taking it. Together, you can select an appropriate probiotic that is the most suitable for you because probiotics aren’t all the same, and have different health benefits. One such probiotic is Florastor® which contains Saccharomyces boulardii CNCM I-745 (S. Boulardii). It is a type of yeast well known and recommended to reduce the incidence of antibiotic associated diarrhea to support a healthy digestive system by promoting helpful gut flora and strengthening the immune system (Bowman, 2017).

Research into S. Boulardii dates back to the 1990s. Recent studies have determined that S. Boulardii not only reduces the risk of antibiotic associated diarrhea but also lowers the recurrence rate of C. diff infection. In fact, a 2017 systematic review and meta-analysis concluded that S. Boulardii reduced the risk of antibiotic associated diarrhea caused by C. Diff, while a systematic review and meta-analysis published out of The American Journal of Gastroenterology confirmed the efficacy of S. Boulardii in reducing the recurrence rate of C. diff infections (Goldenberg, 2017; Tariq et al., 2021).

References

American College of Gastroenterology. (2021, October 26). C. difficile infection. Retrieved February 7, 2023, from https://gi.org/topics/c-difficile-infection/

Bowman, J. (2017, September 2). What yeast is good for the gut? Healthline. Retrieved February 8, 2023, from https://www.healthline.com/health/what-yeast-is-good-for-the-gut

Centers for Disease Control and Prevention. (2021, July 20). Prevent the spread of C. Diff. Centers for Disease Control and Prevention. Retrieved February 8, 2023, from https://www.cdc.gov/cdiff/prevent.html#anchor_1540398219

familydoctor.org. (2020, January 3). Clostridium difficile (C. diff.) infection: Causes and risks. Retrieved February 8, 2023, from https://familydoctor.org/condition/clostridium-difficile-c-diff-infection/

Goldenberg, J. Z., Yap, C., Lytvyn, L., Lo, C. K., Beardsley, J., Mertz, D., & Johnston, B. C. (2017). Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. The Cochrane database of systematic reviews, 12(12), CD006095. https://doi.org/10.1002/14651858.CD006095.pub4

HealthLink BC (n.d.). Clostridioides Difficile (C. diff) Colitis. Retrieved February 10, 2023, from https://www.healthlinkbc.ca/health-topics/clostridioides-difficile-c-diff-colitis

Hill, C., Guarner, F., Reid, G., Gibson, G.R., Merenstein, D.J., Pot, B., Morelli, L., Canani, R.B., Flint, H.J., Salminen, S., Calder, P.C., & Sanders, M.E. (2014). The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nature Reviews Gastroenterology & Hepatology, 11(8), 506-514. https://doi.org/10.1038/nrgastro.2014.66.

Mada, P.K., Alam, M.U. (2022, May 1). Clostridioides Difficile – StatPearls [Internet], NCBI Bookshelf. StatPearls Publishing. Retrieved February 8, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK431054/

Pereira, J. A., McGeer, A., Tomovici, A., Selmani, A., & Chit, A. (2020, January 1). Incidence and economic burden of clostridioides difficile infection in Ontario: A retrospective population-based study. CMAJ Open. Retrieved February 9, 2023, from https://www.cmajopen.ca/content/8/1/E16

Public Health Agency of Canada. (2014, May 2). Government of Canada. Canada.ca. Retrieved February 6, 2023, from https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

Tariq, R., Yadav, D., Tahir, M. W., Sehgal, K., Pardi, D., & Khanna, S. (2021). S136 efficacy of saccharomyces boulardii for prevention of Clostridioides Difficile Infection: A systematic review and meta-analysis. American Journal of Gastroenterology, 116(1). https://doi.org/10.14309/01.ajg.0000773016.43460.eb