About C. Difficile Infection

The following excerpts are from the American Gastroenterological Association's FMT website, a helpful resource for patients, physicians, and the public to learn about FMT and its uses, especially regarding treatment of C. difficile infection. 

Clostridium difficile, or C. difficile for short, can be a very aggressive intestinal bug. Each year, this rod-shaped bacterium infects roughly 500,000 people in the U.S., sending more than 347,000 to the hospital for treatment. In extreme cases, C. difficile infection can be fatal, with estimates of C. diff-associated death ranging from 14,000 to 30,000 annually. C. difficile infection costs the U.S. $1 billion each year.

C. difficile can be found in the soil, air, water, and human and animal feces. Perhaps as many as 10 percent of the population carry the bacteria with no ill effects or symptoms. However, these individuals shed the bacteria through their feces. When people who carry C. difficile do not wash their hands after going to the bathroom, they can contaminate the food they handle and they can leave the bacteria on things they touch. The bacteria then produce spores (a dormant form of the bacteria) that can survive for months unless the area is thoroughly cleaned with products specifically designed to kill them, such as cleansers that contain bleach. If you touch a surface contaminated with C. difficile, you may accidentally ingest the spores when you touch your food or your mouth.

C. difficile is most common in hospitals and long-term care facilities, like nursing homes. Studies suggest that up to 20 percent of hospital patients and 50 percent of people in long-term care facilities carry C. difficile, even if they do not have any symptoms. Unless a hospital or facility follows special procedures for cleaning and disinfection, the spores can remain on beds, toilets and medical equipment. If health-care providers and other facility staff do not wash their hands properly, they can transmit the bacteria from patient to patient. As many hospital patients and long-term care residents are already in a weakened condition because of illness, injury or age, C. difficile can spread throughout these facilities very quickly.

If you are healthy, you will most likely not develop an infection with C. difficile. Other organisms normally present in your gastrointestinal (GI) tract keep it in check by occupying the sites where C. difficile could attach and multiply. Think of these sites as parking spaces — if another organism is already there, C. difficile has nowhere to park.

However, taking antibiotics can wipe out these helpful organisms. With fewer organisms to occupy sites on the intestinal lining, C. difficile can establish itself in the intestine and grow. It then produces toxins that destroy cells and cause inflammation, resulting in symptoms, primarily diarrhea.

C. difficile is responsible for between 15 and 25 percent of cases of antibiotic-related diarrhea. Although other bacteria and organisms can colonize the intestine and make you sick because of antibiotics, C. difficile is often more stubborn and more likely to come back.

A promising new treatment for debilitating recurrent Clostridium difficile infection has developed outside the usual drug-development process, and the treatment isn’t a chemical compound, but microbes that live in the human gut.

Physicians have discovered that giving C. difficile patients microbes from the human gut can cure the infection. The key is transplant of fecal material, which contains a highly complex and dense community of microbes that include bacteria, fungi and viruses, many of which have not been fully characterized. This microbiome is a dynamic and living consortium.

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