Prolonged C. diff infections: A risk to the gut

If you've ever had diarrhea, you are aware of how fast it wears you out. Imagine a case that drags on forever or reappears repeatedly.

This is the situation for over 500,000 Americans who contract the bacterial infection known as Clostridioides difficile, or C. diff., annually. Life-threatening conditions include violent diarrhea and intestinal inflammation.

You'll learn about the typical symptoms, how C. diff spreads and produces toxins, and who is most susceptible from this overview.

C. diff spreads in what way?
We have C. diff in our feces, just like many other bacteria do. Almost everyone carries it; it's on our skin and even on the bottoms of our shoes. The C. diff bacteria are dormant spores while they are outside the body. Their sole opportunity to come into action is when they are ingested and make it to the intestines.

Many people who ingest C. diff spores never get sick, even in that case. The only individuals who feel ill from the spores are those whose gut microbiome, or the billions of microorganisms that reside in their intestines, becomes unbalanced for any of the several causes listed below. The spores begin to grow and produce toxins when an imbalance takes place, which results in a C. diff infection.

C. diff bacteria colonize many of us with no negative effects. Spores of Candida diff are continuously ingested by us. It is only in certain situations that the spores will sprout and emit poison. The toxin is the cause of your illness.

What signs indicate an infection with C. diff?
The symptoms bear similarities to several different forms of digestive problems. This might initially make it challenging to distinguish the infection from less serious conditions.

Signs to look out for include

persistent diarrhea that lasts for three days or longer
nausea, fever, discomfort or pain in the stomach, or loss of appetite.

Although there is no need for the general public to be afraid of C. diff, if you are prescribed an antibiotic, watch out for signs of diarrhea after the medication has finished. When you stop taking the antibiotic, the diarrhea that is related to the drug alone should go away.

Who is most at risk?
From the Centers for Disease Control (CDC), here are some frightening statistics:

The most common cause of illnesses linked to healthcare in the US is C. diff.
It disproportionately affects residents of nursing homes and hospitals.
One in eleven adults over 65 who are diagnosed with a C. diff illness related to medical treatment pass away within a month.

Nonetheless, the illness can also affect other populations. While C. diff infections linked to healthcare facilities are leveling off, infections that affect the general public and are referred to as community-based are rising.

Individuals most prone to getting these infections:

Are on antibiotics or just completed an antibiotic treatment cycle. As per the CDC, the risk of contracting C. diff is tenfold higher in individuals who are taking antibiotics or in the month that follows. Not every patient receiving antibiotics develops C. diff, and not every patient developing C. diff has recurrent C. diff.

Your gut microbiota, your host response, and any unique risk factors you may have—like immunosuppression or inflammatory bowel disease—all play major roles in this possess a compromised immune system as a result of immunosuppressive medication therapy, organ transplantation, or cancer (such as those with autoimmune diseases or inflammatory bowel disease). Have an intimate relationship with an individual who has been diagnosed with C. diff.

Which preventative measures aid in stopping the spread of C. diff?
Hospitals use a variety of strategies to try to stop C. diff in their patients. They enforce strict handwashing protocols for employees. Patients are screened for C. diff infection if they experience new diarrhea. To stop it from spreading, those who have it have been isolated in their own rooms.

You may help avoid this intestinal illness outside of a hospital by taking a few common-sense precautions.

Every time you use the restroom and before you eat, thoroughly wash your hands with soap and water. Having clean hands is especially crucial if you have had C. diff. or know someone else who has. By the way, because C. diff organisms may produce spores that are resistant, alcohol-based hand sanitizers are ineffective against the pathogen.

The biggest thing we can do is advocate for ourselves, the saying goes. Take antibiotics only when strictly necessary and for the shortest period of time possible." We know that many unneeded antibiotic prescriptions are made during the cold and flu season for symptoms that are most likely viral, not bacterial. Antibiotics do not eradicate viruses, and overuse of them might disturb the delicate balance of microorganisms in your digestive system. Consult your physician: Is this medication necessary? Is there a substitute?

If you do require antibiotics, find out if a narrow-spectrum medication works well for the illness you have. How come? Broad-spectrum antibiotics are effective at killing a wider variety of microorganisms. The caveat is, we don't want patients to not take the antibiotics they need for an actual infection, the doctor said. This may be overkill, depleting your gut microbiome unnecessarily and encouraging C. diff bacteria to germinate. But speak with your medical team about it.

A study published in the journal Open Forum Infectious Diseases in 2023 found that the kind of antibiotic administered had an impact as well. More than 159,000 individuals with C. diff infection were compared to 797,000 healthy controls by the researchers. The use of medicines such as clindamycin and later-generation cephalosporins appears to carry the highest risk of C. diff infection, according to study results. The drugs doxycycline and minocycline, on the other hand, were linked to the lowest risk.

Can a C. diff infection be treated or prevented with probiotics?
Probiotics are living bacteria that are present in yogurt, supplements, and other fermented foods that can support intestinal health. Different strains of Lactobacillus and Bifidobacterium are two well-known examples.

Probiotics haven't been shown to stop C. diff from occurring or recurring, though. Studies conducted on both humans and animals indicate that administering probiotics following an antibiotic course may impede the rate of microbiome repair. Using probiotics could cause you to slow your microbiome's recovery.

How is an infection with C. diff treated?
Ironically, despite the fact that antibiotic usage contributes to the spread of the illness, C. diff therapy usually begins with antibiotics. The recommended antibiotics are oral vancomycin or fidaxomicin.

But one in five people will experience one or more recurrences, and the likelihood of another recurrence increases with each one. In the event that people haven't adequately cleansed their houses, a repeat episode may occur. This keeps individuals susceptible to re-infection with the same strain of C. diff.

Fecal microbial transplants (FMT) are thought to be the best course of action when C. diff recurs. Fecal matter from a healthy donor is transplanted into the stomach of a patient using fecal matter transfer via endoscopy, enema, or oral capsule. This year, the FDA granted licenses to two live fecal microbiota products with the intention of preventing recurrent C. diff infections.

Although we still need antibiotics to treat this illness, we also have several prevention measures at our disposal. For those who are battling C. diff infections, it's undoubtedly quite exciting.

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