{"id":55665,"date":"2023-12-04T15:27:59","date_gmt":"2023-12-04T15:27:59","guid":{"rendered":"https:\/\/cdhf.staging.not4prod.com\/?p=55665"},"modified":"2025-01-08T13:50:24","modified_gmt":"2025-01-08T13:50:24","slug":"clostridium-difficile-infection-frequently-asked-questions","status":"publish","type":"post","link":"https:\/\/cdhf.ca\/en\/clostridium-difficile-infection-frequently-asked-questions\/","title":{"rendered":"Clostridium Difficile Infection: Frequently Asked Questions"},"content":{"rendered":"\n

In \u201cClostridium Difficile<\/a>\u201d, we began discussing Clostridium Difficile Infection (CDI). In this article, we will delve deeper into this topic, but first – let’s start with a quick recap. You may recall that CDI is an infection caused by the bacteria Clostridium difficile <\/em>or C. diff <\/em>for short, infecting the large intestine. C. diff can be found everywhere in the environment from soil, air, and water to everyday objects such as doorknobs and counter tops. It can also be found in the intestines of up to 3% individuals, as part of the gut flora (\u201cClostridium Difficile\u201d, n.d.). Symptoms of CDI can range from mild to severe with typical symptoms being watery diarrhea and abdominal cramping. Severe CDI includes more frequent diarrhea, fever, bloody stool and in some cases even death (\u201cYour risk\u201d, 2022). <\/p>\n\n\n\n

How does C. Diff<\/em> Spread?<\/h2>\n\n\n\n

C. diff <\/em>can live outside the body as spores which are \u201cinactive\u201d or \u201cdormant\u201d forms of the bacteria. C. diff <\/em> spores are difficult to kill, persisting for months to years (Bruno-Murtha, 2020). They <\/em>spread by something known as \u201cfecal-oral transmission\u201d i.e. they are carried from person to person in feces. Poor hand hygiene can help spread C. diff<\/em> to people or to objects that are touched. They enter the body through the mouth and begin to reproduce in the intestines releasing toxins that damage tissues and destroy cells causing diarrhea and other gastric symptoms (\u201cClostridium Difficile\u201d, n.d.). Historically CDI was thought to be an infection confined to hospitals and care homes. Not only was antibiotic use common in these facilities but people were in close proximity to each other, and health care providers tended to many patients, increasing the likelihood of transmission. Not to mention, C. diff is hard to kill, without the use of certain disinfectants, so it can persist in the environment. Lately, statistics have been demonstrating an increasing rate of CDI in the community as well (\u201cClostridium Difficile\u201d, n.d.; Velez, 2022). <\/p>\n\n\n\n

Can antibiotics give you C. Diff?<\/em><\/h2>\n\n\n\n

According to the Centre for Disease Control (CDC), you are 7-10 times more likely to get CDI while on antibiotics or within a few days-weeks after taking antibiotics (\u201cYour risk\u201d, 2022). However, simply using a prescribed antibiotic does not necessarily mean you will get CDI. There are other factors that may make you more susceptible to CDI such as a weakened immune system, being over the age of 65, prolonged hospitalization or living in a nursing home (\u201cClostridium Difficile\u201d, n.d.). <\/p>\n\n\n\n

So why is C. diff <\/em>associated with antibiotics? Antibiotics are a type of medication that can help prevent or treat an infection caused by bacteria. Unfortunately, there are instances where antibiotics not only kill the \u201cbad\u201d bacteria but also harm the \u201cgood\u201d or \u201cbeneficial\u201d bacteria (\u201cYour risk\u201d, 2022). As you may know, the intestines are home to trillions of bacteria, known as the gut flora or gut microbiota, which play a key role in metabolism, immune system and even mood (\u201cClostridium Difficile:, n.d).  Loss of \u201cgood\u201d bacteria disrupts the natural balance of gut flora\/microbiota, prompting C. diff<\/em> to grow and multiply out of control and produce toxins (chemicals) causing your health to suffer. Consequently, it is important to use antibiotics responsibly, as prescribed by health care providers. <\/p>\n\n\n\n

What to do if you are newly diagnosed with C. Diff<\/em><\/h2>\n\n\n\n

If you have been newly diagnosed with CDI, it is essential that you are mindful of good hygiene. This means thoroughly washing your hands with soap and water. Proper hand hygiene involves washing all the surfaces of the hands, wrists and fingers for at least 20 seconds; a rule of thumb that healthcare providers closely follow (\u201cKeeping hands\u201d, 2022). It\u2019s said that singing the \u201chappy birthday\u201d song twice serves as a good 20-second timer. Check out this video<\/a> on effective hand washing technique by WHO (\u201cWHO: How\u201d, 2015). And don\u2019t forget that alcohol-based hand sanitizers are ineffective against C. diff. <\/em>Frequently clean high-touch surfaces or common areas with special cleaning products containing chlorine bleach that are sporicidal (spore killing). Try to use a separate bathroom but if you have a shared facility, carefully clean areas such as sinks, toilet seats, flushers and door handles. <\/p>\n\n\n\n

If you have friends, loved ones, acquaintances, or colleagues with weakened immune systems, it\u2019s best to avoid contact to limit exposure to C. diff<\/em>. It\u2019s also recommended that you do not return to work or school until after your symptoms have ended, with some experts even recommending continued contact precautions until least 48 hours post diarrhea cessation to minimize risk of transmission. Speak to your doctor, employer, or your child\u2019 school or daycare center to determine what is best (\u201cPreventing the\u201d, n.d). <\/p>\n\n\n\n

I’ve heard that you can get CDI again- is that true?<\/h3>\n\n\n\n

Yes! While most individuals will recover, approximately, 1 in 6 patients with CDI can get a recurrent infection and this usually occurs within 8 weeks of a previous episode. Recurrent CDI may be due to a relapse or reinfection i.e. contact with a different strain. With each episode of CDI, the risk of future recurrence increases (\u201cLife after\u201d, 2021; Song and Kim, 2019). So, if you don\u2019t get better or experience worsening symptoms, seek immediate medical help. 

There are steps you can take to minimize transmission of C. diff <\/em>such as implementing contact precautions, appropriate hand hygiene, and environmental cleaning and disinfection (\u201cClostridium difficile\u201d, n.d). <\/p>\n\n\n\n

Treatment Options<\/h2>\n\n\n\n

There are a few treatment options for CDI:<\/strong><\/h3>\n\n\n\n

1. Antibiotics – Interestingly, C. diff <\/em>is treated by the very same category of medications, i.e. antibiotics, which causes it to flourish in the gut. The most commonly used antibiotics include Vancomycin, Metronidazole and Fidaxomicin.  Your health care provider will speak with you about the most appropriate antibiotic for resolution of symptoms and infection (Smith et al., 2022; Velez, 2022). 

2. Fecal Microbiota Transplantation (FMT), also known as stool transplantation – This option is generally considered if antibiotics have proven ineffective or if CDI is chronic.  The purpose is to reintroduce healthy bacteria into the gut making it difficult for C. diff <\/em>to thrive. This is done through stool donated by a \u201chealthy person\u201d which is introduced into the patient\u2019s gut either by a tube through the mouth or the rectum or as a capsule, famously known as the \u201cpoop pill\u201d (Smith et al., 2022; Velez, 2022). The \u201cpoop pill\u201d isn\u2019t yet available in the market; that said, it was approved by the FDA earlier this year for adults, 18 years and older, in the United States (\u201cFDA approves\u201d, 2023). <\/p>\n\n\n\n

FMT is offered in centers across Canada and has been approved by Health Canada in the treatment of CDI only; it otherwise remains an experimental treatment in ongoing clinical trials (\u201cGuidance documents\u201d, 2022). Multiple randomized control trials, over the years, have demonstrated that FMT is highly effective in the management of recurrent CDI with rates ranging from 44% to 96% (Hota and Poutanen, 2018). Furthermore, a systematic review and meta- analysis published in 2020 concluded that FMT is safe and effective in managing this condition, but its effects can vary depending upon the delivery method used (Baunwall, 2020).<\/p>\n\n\n\n

Can Probiotics Help with C.Diff? <\/em><\/h2>\n\n\n\n

An option you may have come across for helping with C. Diff is probiotics. Probiotics have been defined as \u201clive microorganisms which when administered in adequate amounts confer a health benefit in the host\u201d (Hill et al., 2014). To put it simply, probiotics are \u201cgood microorganisms\u201d, either bacteria, yeast, or mold, which confer health benefits. They are found in dietary supplements and in some foods such as fortified yogurt or fermented milk products (CDHF, 2022).  They can aid in digestion<\/a>, boost the immune system and may even impact mood and cognition (though it is too soon to say as research remains ongoing) (\u201cProbiotics may\u201d, <\/em>2023). Not all probiotics are the same and different microbes may have different effects (Velez, 2022; CDHF 2022). 

Florastor all-in 1 probiotic contains the yeast Saccharomyces boulardii CNCM 1-745 (S. boulardii), <\/em>a unique strain studied over 65 years and researched in over 130 clinical trials <\/em>(De Santis, 2023). Research has shown that S. boulardii<\/em> can reduce the incidence of antibiotic associated diarrhea<\/a>. Systematic reviews and meta-analysis published in 2017 and 2021 concluded that S. boulardii<\/em> reduced the risk of antibiotic associated diarrhea and recurrent C. diff<\/em> infections, respectively (Goldenberg, 2017; Tariq et al., 2021). Moreover, in an experimental trial, it was discovered that S. Boulardii<\/em> substantially decreased the recurrence rate of C Diff. infection. Among those who received a placebo, 64.7% experienced infection recurrence, while only 34.6% of those taking S. Boulardii<\/em> encountered the same issue. (Surawicz et. al, 2000).<\/p>\n\n\n

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This information was made possible due to an unrestricted educational grant from Florastor.<\/p><\/p>

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