Q. What is Clostridium difficile?

C. difficile is a spore-forming bacterium which is present as one of the normal bacteria in the gut of up to 3% of healthy adults. People over the age of 65 are more susceptible to developing illness due to these bacteria.

C. difficile diarrhoea occurs when the normal gut flora is altered, allowing C. difficile bacteria to flourish and produce a toxin that causes a watery diarrhoea.

Procedures such as enemas and gut surgery, and drugs such as antibiotics and laxatives cause disruption of the normal gut bacteria in this way and therefore increase the risk of developing C. difficile diarrhoea.

Q. What are the symptoms of C. difficile infection?

The effects of C. difficile can vary from mild to severe diarrhoea and, much more unusually, to severe inflammation of the bowel.

Other symptoms can include fever, loss of appetite, nausea and abdominal pain or tenderness.

Q. How do you catch it?

It is possible for the infection to spread from person to person because people suffering from C. difficile -associated disease shed spores in their faeces. Spores can survive for a very long time in the environment and can be transported on the hands of health care personnel who have direct contact with infected patients or with environmental surfaces (floors, bedpans, toilets etc.) contaminated with C. difficile.

Q. Who does it affect? Are some people more at risk?

The elderly are most at risk, over 80% of cases are reported in the over 65-age group. Patients with a weak immune system are also at risk. Children under the age of 2 years are not usually affected.

Q. How do doctors diagnose C.difficile infection?

It is difficult to diagnose C difficile infection on the basis of symptoms alone.

The infection is normally diagnosed by carrying out laboratory testing which shows the presence of the C difficile toxins in the patient’s faecal sample. A sample of faeces has to be sent to the microbiology laboratory. The test result is usually available within 1-2 days.

Q. How can it be treated?

C. difficile can be treated with specific antibiotics such as metronidazole. There is a risk of relapse in 20-30% of patients and other treatments may be tried, including pro-biotic (good bacteria) treatments, with the aim of re-establishing the balance of flora in the gut. Most cases of C.difficile diarrhoea make a full recovery. However, elderly patients with other underlying conditions may have a more severe illness. Occasionally, infection in these circumstances may be life threatening.

Q. What should I do to prevent the spread of C. difficile?

If you are infected you can spread the disease to people that are hospitalized or on antibiotics and are likely to become ill. In order to reduce the chance of spreading the infection to others: it is advisable to wash hands with soap and water, especially after using the toilet and before eating. Surfaces in bathrooms, kitchens and other areas should be cleaned on a regular basis with household detergent/disinfectants. For this organism, alcohol hand rubs are less effective than soap and water.

Q. How can hospitals prevent the spread of C.difficile ?

Unfortunately patients with diarrhoea, especially if severe or accompanied by incontinence, may unintentionally spread the infection to other patients, which may lead to outbreaks of C. difficile in hospitals. In addition, the ability of this bacterium to form spores enables it to survive for long periods in the environment, e.g.. on floors and around toilets, and disseminate in the air, e.g. during bed making.

Staff wear disposable gloves and aprons when caring for infected patients and affected patients may be segregated from others. Rigorous cleaning with warm water and detergent is probably the most effective means of removing spores from the contaminated environment. It is essential that staff, patients and visitors use soap and water for hand hygiene.

Q. I have heard that some patients are at increased risk for C. difficile – associated disease. Is that true?

That is true - the risk for disease increases in patients with the following:

• antibiotic exposure
• gastrointestinal surgery/manipulation
• long length of stay in healthcare settings
• a serious underlying illness
• immunocompromising conditions
• advanced age

Q Has a new type of C difficile infection been detected recently?

The HPA has initiated a sampling scheme to detect new types of C difficile infection. A new type of C difficile closely related to one previously found in North America has recently been detected in several parts of the country.