Clostridium difficile

***Clostridium difficile*** is a species of bacteria.  It is often called _C. diff_ (pronounced "see diff").  It is a gram-positive bacteria which belongs to the genus _Clostridium_.

_C. diff _can live in the human colon (the large intestine) without causing any problems.  About 2-5% of adults have _C. diff_ living in their colons. However, in some people, _C. diff _causes serious illness.  In these people, _C. diff _bacteria grow out of control in the colon.   The bacteria attack the lining of the intestines.  This causes a problem called _C. diff _colitis.  Colitis is inflammation (swelling) of the colon.

_C. diff _infection is getting more and more common in hospitals, nursing homes, and other health care facilities.    It kills about 14,000 people a year just in the United States.

## _C. diff_ infection

The most common symptom of _C. diff _infection is severe diarrhea.  _C. diff _infection can also cause fever, belly pain, loss of appetite (not wanting to eat), and nausea.

Some cases of _C. diff_ infection are not very serious.  In other cases, people get very sick and even die. When people experience severe diarrhea from _C. diff_ infection, they may become badly dehydrated (not have enough fluid in their bodies).  This can damage the kidneys leading to renal failure.  _C. diff_ bacteria can also eat a hole in the intestines (perforation), which is very dangerous.

Once a person has _C. diff_ infection, they can spread the infection to other people.  _C. diff _can live for a long time on surfaces like doorknobs, sheets, and medical equipment.  If a person with _C. diff _infection does not clean their hands, they can spread the bacteria to other people on their hands.

## Who gets _C. diff_ infection?

_C. diff_ infection usually happens in people who are taking antibiotic medicine.   Usually, the intestines are filled with good, healthy bacteria.  These healthy bacteria keep _C. diff_ bacteria under control.  If antibiotic medicines kill the healthy bacteria, _C. diff_ bacteria can grow out of control.

_C. diff_ infection is also more common in:
- People in hospitals, nursing homes, and other health care facilities
- People who are 65 years old or older
- People with weak immune systems (in the body, the immune system is in charge of fighting disease)
- People who have just had surgery on their intestines
- People with colon problems, like inflammatory bowel disease or colon cancer
- People who take antacid medicines called proton pump inhibitors.  (These medicines cause the stomach to make less acid.  Normally, stomach acid helps keep bacteria like _C. diff_ under control.)

## How is _C. diff _infection treated?

_C. diff _infection can be treated with some antibiotic medicines.  However, _C. diff_ is an antibiotic-resistant bacteria.  This means that many antibiotic medicines cannot kill _C. diff_.  This can make _C. diff_ infection very difficult to treat.  Many people with _C. diff_ infection have relapses (they get better for a while, but then get sick again).  This happens to about one in every five people with _C. diff_ infection.

Usually, doctors try an antibiotic called metronidazole as the first treatment for _C. diff_ infection. About three in every four people with _C. diff_ infection get better after taking metronidazole for ten days.  When metronidazole does not work, doctors give other antibiotics, usually vancomycin or fidoxamacin.

In severe cases of C. diff infection which do not get better with antibiotics, doctors may do surgery to remove parts of the colon.

Fecal transplantation, especially for those with recurrent _C. diff_ infections, has been shown to be more effective than oral vancomycin.

## How can _C. diff_ infection be prevented?

Usually, _C. diff _infection can be prevented.  Hand-washing is one of the best ways to prevent _C. diff_ infection.  If a person has _C. diff_ bacteria on their hands, they can kill the bacteria by washing their hands with soap and water.   _C. diff_ bacteria on surfaces (like doorknobs and medical equipment) can be killed with bleach.  Many hospitals and other health care facilities have special bleach wipes which kill _C. diff_.  Washing sheets and clothes with bleach and detergent also kills _C. diff_.

Alcohol does not kill _C. diff_, so instant hand sanitizer and alcohol wipes will not keep _C. diff_ bacteria from spreading.

Hospitals and other health care facilities can also use "_C. diff_ precautions" to prevent _C. diff_ from spreading.   (Precautions are ways of being careful.)  When a patient has _C. diff_, health care workers can keep the bacteria from spreading by:
- Using gloves and then washing their hands every time they touch the patient, the patient's things, or anything in the patient's room
- Cleaning medical equipment with special bleach wipes every time they use it
- Cleaning the patient's things and the patient's room with bleach
- Giving patients with _C. diff_ infection private rooms, or putting them only with other patients who have _C. diff_ infection