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Clostridioides difficile infection (C. difficile or C. diff)

Clostridioidesum difficile infection, or C. diff, is a serious bacterial infection that often causes diarrhea and severe stomach pain. It's most common in older people or people with weakened immune systems.

Doctors treat C. diff with antibiotics, but there are other treatments, too. C. diff can recur, but there are ways you can reduce your risk of it coming back.

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What Is C. difficile?

C. difficile, or C. diff, is a bacteria that causes problems in the digestive system. This germ causes inflammation in the colon (colitis), leading to diarrhea and other symptoms.

C. diff infections are most common in people who took antibiotics for another infection.

About 500,000 C. diff infections happen in the U.S. each year.

C. diff can also recur despite a good first response to the anti-C. diff therapy.

C. diff returns in about one in six people, usually within the two to eight weeks after stopping anti-C. diff therapy. But it can take as long as three months to come back.

What causes a C. difficile infection?

C. diff bacteria gets into the digestive tract through contact with food or surfaces contaminated with C. diff spores.

In most people, our gut's protective microbes keep C.diff from causing any problems.

But antibiotics may harm the good protective microbes that allow the body to fight off C.diff. This can lead to the bacteria becoming active in the gut, which then causes symptoms.

C. diff spores are all around us, but they're more common in hospitals and nursing homes.

What are C. difficile risk factors and complications?

C. diff risk factors

Older people and people with existing health problems are more likely to get a C. diff infection.

C. diff is also contagious. You can get it if you're around someone who has it.

Risk factors of C. diff include:

  • Being age 65 or older.
  • Having a weakened immune system. Solid organ or bone marrow transplants, HIV/AIDS, or certain medicines can weaken your immune system.
  • Having had a past infection of C. diff.
  • Having certain chronic health issues, such as cancer, kidney disease, or inflammatory bowel disease.
  • Staying in a hospital or nursing home.
  • Having had a recent surgery in the digestive system.
  • Taking medicines called proton pump inhibitors to treat problems from stomach acid.

C. diff complications

Without treatment, C. diff can cause severe problems or even death.

Complications include:

  • Damage to the bowels.
  • Hole in the large intestine.
  • Kidney failure.
  • Severe dehydration that makes you sleepy, confused, faint, or have a rapid heartbeat.
  • Death.

How can I reduce my risks of C. diff?

To lower your risk of C. diff, only take antibiotics as prescribed by your doctor. Don't stop taking antibiotics early or for longer than your doctor says.

If you're taking care of someone with C. diff, you can take steps to reduce your risk of infection by:

  • Washing your hands and taking showers often with soap and water.
  • Cleaning surfaces that the person with C. diff touches, such as doorknobs, countertops, sinks, and toilet handles. Use bleach or a cleaning solution with bleach to disinfect.
  • Using a different bathroom than the person who has C. diff, if you can.
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What Are the Signs and Symptoms of a C. difficile Infection?

Symptoms of C. diff tend to begin a few days after you start taking antibiotics. But they can also appear after you stop taking them.

Common C. diff symptoms include:

  • Diarrhea.
  • Stomach pain.
  • Nausea, vomiting.
  • Lack of appetite.
  • Rapid weight loss.

Many people who take antibiotics often have mild diarrhea or stomach upset. But if the diarrhea or pain is severe or lasts a few days, see a doctor right away.

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How Do You Diagnose C. difficile?

To help diagnose C. diff, your doctor will ask you about your history and symptoms.

They'll likely ask for a stool (poop) sample to send for lab testing. A stool test is one of the most common ways to diagnose C. diff.

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How Do You Treat C. difficile?

The goal of treating C. diff is to kill the bacteria that causes the infection.

Antibiotics to treat C. diff

To get rid of your infection, your doctor will prescribe one of the antibiotics active against C. diff such as:

  • Fidaxomicin.
  • Vancomycin.
  • Metronidazole.

You'll take this medicine for 10 days or longer. Your doctor may tell you to stop taking other antibiotics at the same time.

If you have recurrent episodes of C. diff, you may need a different antibiotic or longer course of treatment.

FDA-approved C. diff therapies

In addition to antibiotics, there are FDA-approved therapies to prevent repeat episodes of C. diff.

These include:

  • Bezlotoxumab (Zinplava), an IV infusion of antibodies against toxin B.
  • REBYOTA, an enema that contains good gut microbes from healthy donors.
  • VOWST, capsules that have good gut microbes.

Fecal microbiota transplantation (FMT) to treat C. diff

FMT, or whole stool microbiota transplantation, is an experimental procedure doctors may also consider for certain recurrent C. diff cases.

FMT involves transferring specially prepared stool from a healthy donor into the intestine of a person with C. diff infection. These healthy gut bacteria from the donor can increase protection against further episodes of C. diff.

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