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 contact – hence 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
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
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
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.
Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009.
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