15.1.1.2.2: Clostridium difficile
- Page ID
- 42651
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Organism
- Recently renamed Clostridioides difficile
- Clostridioides difficile is a Gram-positive endospore-forming rod
- Strict anaerobe
- Catalase negative
- Also known informally as C. diff
Habitat
- Widely distributed in the environment, often soil water, hay, and sand
- Endospores can remain on contaminated surfaces for extremely long periods of time
- Also present in intestinal flora of infected individuals and asymptomatic carriers
Source
- Most frequently infection occurs in health care facilities via the fecal-oral route or by contact with contaminated materials.
- Can also be acquired in non-health care settings (community acquired) through environmental exposure
- Proper disinfection and infection control measures are critical to prevent the spread of C. diff in health care facilities:
- C diff endospores are released in large quantities in the feces of infected patients and even asymptomatic carriers
- Alcohol-based hand sanitizers do not kill the endospores of C diff, which necessitates the use of gloves and rigorous handwashing
- Follow all control measures as set forth by relevant authorities (for example: https://www.health.state.mn.us/diseases/cdiff/hcp/ic.html)
Epidemiology
- Primarily considered a nosocomial (health care associated) infection, but community acquired C. diff is becoming more common
- In 2017, there were an estimated 223,900 cases in hospitalized patients and 12,800 deaths in the United States [Source: 2019 AR Threats Report]
- Infection is most often, but not exclusively, associated with use of broad-spectrum antibiotics. These broad spectrum antibiotics destroy the normal intestinal flora and allow the C. diff to gain a foothold. C. diff also tends to be more antibiotic resistant than most of the normal flora, allowing it to survive in the presence of the antibiotic treatment.
Clinical Disease
- Referred to by a variety of names including:
- C. difficile associated disease (CDAD)
- C. difficile infection (CDI)
- Antibiotic-associated colitis
- Pseudomembranous colitis
- Symptoms include diarrhea and abdominal cramping, sometimes accompanied by fever and/or nausea
- In severe disease, the intestinal lining is killed and sloughs off into the feces as pseudomembranes
- CDAD can cause intestinal bleeding, low blood pressure, megacolon, and even intestinal perforation. In these most sever cases it can be fatal.
- Treatment includes
- ceasing the broad-spectrum antibiotic and using antibiotics (such as vancomycin) which will target C. diff
- occasionally surgery in most severe cases
- because the infection was able to establish due to impaired intestinal flora, fecal transplants have become standard treatment over the last ten years or so and have an extremely high rate of success (80-90%).
Primary Virulence Factors
- Two exotoxins:
- Toxin A, an enterotoxin, causes fluid accumulation in the intestine
- Toxin B, a cytotoxin, kills the cells of the intestinal lining
Additional information: