CLOSTRIDIUM DIFFICILE INFECTION Clostridium difficile infection (CDI) is a symptomatic infection due to the spore-forming bacterium, Clostridium difficile. Symptoms include watery diarrhea, fever, nausea, and abdominal pain. People are most often infected in healthcare settings, e.g., hospitals and nursing homes, following antibiotic treatment for other infections and contact with objects or surfaces contaminated with C. difficile spores. Healthcare workers who have been exposed to the spores can therefore spread the bacteria to patients or contaminate surfaces through hand contact. Indeed, the rate of C. difficile acquisition is estimated to be 50% or more in patients with hospital stays longer than four weeks. Systemic antibiotic use, including (but not limited to) any penicillin-based antibiotic such as ampicillin, cephalosporins, and clindamycin, appears to be an essential requirement for CDI. These antibiotics alter normal bacterial flora of the bowel, killing off other “normal” competing bacteria in the intestine, and any bacteria remaining will have less competition for space and nutrients. The net effect is to permit more extensive, abnormal growth of certain bacteria such as Clostridium difficile. Primary CDI generally respond well to a 10-14 day course of oral metronidazole, vancomycin or fidaxomicin and treated patients are usually discharged within two weeks.
The most effective method for preventing CDI is proper and prudent use of antimicrobial therapy, i.e., antibiotics, to minimize disruption of normal GI tract flora. In the hospital setting, where CDI is most common, nearly all patients who develop CDI are exposed to antimicrobials. Containment by housing infected individuals in private rooms is also an important measure to prevent the spread of C. difficile between patients. Rigorous infection protocols by healthcare personnel are required to minimize this risk of transmission and may include wearing gloves, single patient use of noncritical medical devices for individuals with CDI, washing with soap and water will eliminate the spores from contaminated hands (note alcohol-based hand rubs are ineffective), bleach wipes containing 0.55% sodium hypochlorite have been shown to kill the spores on skin and surfaces, installing lidded toilets and closing the lid prior to flushing reduces the risk of contamination, and use of appropriate disinfectants such as those containing a 10:1 ratio of water to bleach and hydrogen peroxide vapor (HPV) systems to sterilize a CDI patient room to reduce risk of infection to subsequent patients.