Clostridioides difficile, commonly known as C. diff, is a bacterial infection that causes persistent diarrhea and inflammation of the colon. For nearly half a million Americans each year, this infection is not only severe but can also become life-threatening. While some recover after treatment, others suffer recurring episodes, often lasting for months or even years.
Understanding how C. diff spreads, its symptoms, and the risk factors associated with the infection is essential for prevention and effective treatment. Experts, including Dr. Jessica Allegretti of Brigham and Women’s Hospital, emphasize the importance of gut microbiome balance and highlight new treatment strategies for combating this stubborn infection.
C. diff bacteria are present in the environment and can be found in soil, water, and even on surfaces. The bacteria exist in an inactive spore form outside the body and become active only when ingested. Once inside the intestines, they can multiply and release harmful toxins, leading to severe diarrhea and inflammation.
Most people are exposed to C. diff without falling ill. However, an imbalance in the gut microbiome often caused by antibiotic use can create an environment where C. diff spores can flourish and trigger infection.
“Many of us are colonized with C. diff bacteria without any consequences,” explains Dr. Allegretti. “Only under the right circumstances will the spores germinate and release a toxin. It’s the toxin that makes you sick.”
C. diff infections often mimic other gastrointestinal illnesses, making early diagnosis difficult. Common symptoms include:
- Persistent diarrhea lasting three or more days
- Nausea
- Fever
- Stomach pain or tenderness
- Loss of appetite
Because symptoms can be similar to other conditions, medical professionals often look for a recent history of antibiotic use when diagnosing a C. diff infection.
Certain groups of people are more vulnerable to C. diff infections. According to the Centers for Disease Control and Prevention (CDC), those most at risk include:
- Patients in hospitals and nursing homes
- Individuals over 65, as they face a higher mortality rate
- People who have recently taken antibiotics, as they are up to 10 times more likely to develop a C. diff infection
- Individuals with weakened immune systems, such as cancer patients or organ transplant recipients
- Those who have close contact with an infected person
Hospitals take strict measures to prevent C. diff, such as isolating infected patients and enforcing rigorous handwashing protocols. However, prevention strategies extend beyond healthcare settings.
To reduce the risk of infection:
- Wash hands thoroughly with soap and water, especially after using the bathroom or before eating. Alcohol-based sanitizers are not effective against C. diff spores.
- Avoid unnecessary antibiotic use. Many antibiotics disrupt the gut microbiome, making infections more likely. Always consult a doctor about whether an antibiotic is necessary.
- When antibiotics are required, ask about narrow-spectrum options, which are less likely to harm beneficial gut bacteria.
Despite its association with antibiotic overuse, C. diff infections are commonly treated with antibiotics such as fidaxomicin or oral vancomycin. However, roughly one in five patients will experience recurrent infections.
For those with recurring cases, fecal microbiota transplantation (FMT) has emerged as a highly effective treatment. FMT involves transferring stool from a healthy donor into the patient’s gut to restore microbiome balance. In 2023, the FDA approved two live fecal microbiota products to prevent recurrent C. diff infections.
While research continues, experts remain hopeful that improved prevention and treatment strategies will help reduce the burden of C. diff infections.
C. diff remains a significant health threat, particularly for those with weakened immune systems or recent antibiotic use. While prevention strategies such as proper handwashing and cautious antibiotic use can help reduce infection rates, those who develop persistent symptoms should seek medical attention promptly. With advancements in treatment, including fecal microbiota transplantation, the future looks promising for patients struggling with this challenging infection.
