Clostridium Difficile is carried in the normal gut fauna of the large intestine in about 5% of the population.
  • It can be spread by the faecal-oral route, and by person-person contacthence the importance of hand-washing between patients on the ward!
  • It is also present in soil, water and in pets
Generally, becomes problematic after taking antibiotics and is a very common hospital acquired infection.
  • in some instances it can be acquired and become symptomatic in the abscence of antibiotic use, but this is rare

Pathology

Taking certain antibiotics (e.g. clindamycin, penicillins (amoxicillin, ampicillin) and 3rd generation cephalosporins are most commonly implicated, although loads of others are involved! IV antibiotics present a greater risk than oral) kills off other normal gut bacteria, leaving the way clear for C. difficile to reproduced unchecked, as it is no longer in competition with other bacteria for resources. This overgrowth of C. difficile can cause diarrhoea, and on colonoscopy, the appearance of pseudomembranous colitis (yellow plaques that can be easily dislodged).
  • The symptoms of c diff infection are a result of the toxins produced by the bacteria and not directly of the bacteria itself

Investigations

  • Stool sample for enterotoxins produced by C. difficile
    • Sensitivity + Specificy both 95% – HOWEVER – there are examples of patient deaths from c diff in cases of negative test results, so always consult the micobiologist

Signs and Symptoms

  • Usually occurs approx 5-10 days after antibiotic use but can be anywhere from 1 day to 2 months
  • Diarrhoea ± blood
  • Abdominal discomfort / pain
  • Nausea and vomiting is rare
  • Sepsis (rare)
  • Acute abdomen (rarer)

Treatment

  • Metronidazole – 400mg/8h PO for 8-10 days
    • Vancomycin is often second line, but more expensive
  • It is also often wise to inform the GP of the infection, so that if the need arises to prescribe antibiotics in the future, the GP is able to prescribe metronidazole simultaneously to avoid a recurrence of pseudomembranous colitis.

Related entries