by Jeffrey Silvers, M.D.

Antibiotics play an important role in fighting infections, but overuse can sometimes allow one virulent form of bacteria to multiply: clostridium difficile.

This bacteria, commonly known as C. difficile or C. diff, can be found almost anywhere, and is harmless – unless it enters the digestive system of a person on antibiotics.

Because antibiotics can wipe out the “good” bacteria of the intestinal tract along with the “bad,” an environment is created where a pathogen like C. diff can flourish. With no beneficial bacteria to stop it, C. diff germs multiply rapidly and attack the lining of the intestine, which can lead to severe diarrhea and other serious conditions.

According to the Centers for Disease Control, C. diff is responsible for tens of thousands of cases of diarrhea each year in the U.S. – and numerous death, l. Studies have shown that the incidence of C. diff has tripled in the past 12 years. Further, a more virulent strain, known as NAP1/BI/027, is drawing attention to C. diff because it is more resistant to treatment.

Those most at risk for C. diff include people who have received antibiotics in the previous three months; patients who have recently been hospitalized; adults age 65 or older; and residents of long-term care facilities (within the previous year), as well as patients who have underlying chronic medical conditions such as diabetes, kidney disease, heart disease or cancer.

The symptoms of a C. diff infection can include fever, abdominal pain, nausea, dehydration, and, of course, diarrhea. Anyone who has severe diarrhea for more than 24 hours or blood in their stools should be evaluated by a doctor.

C. diff can spread if an infected person – or caregiver – does not wash their hands thoroughly. Besides moving from person to person through handshakes and other bodily contact, the C. diff bacteria produces spores that can live for weeks or months in inanimate objects touched by the infected patient.

To combat the spread of these bacteria, it is vitally important to keep hands clean and to wash them with warm soap and water especially after coming into contact with anyone or anything within a hospital setting.

Equally important, both doctors and patients alike should work together to minimize the use of antibiotics, especially fluoroquinolones, which are commonly prescribed for bladder infections and respiratory tract infections. The new NAP1/ BI/027 has taken a foothold due to increased use of fluoroquinolones, and is more resistant to previously prescribed antibiotics.

At Eden Medical Center, protocols are in place to rapidly identify patients who might have C. diff infections. Those patients are kept in isolation, while medical staff and visitors are expected to wear gloves and gowns, and exercise thorough hand washing. Environmental cleaning by disinfecting inanimate objects is also standard practice.

While the overuse of antibiotics can precipitate a C. diff infection, the targeted use of drugs like vancomycin work in the majority of infections. However, metronidazole, which has been effective for treating C. diff can no longer control the NAP1/BI/027 strain.

Other modalities are available for treatment and research for prevention and treatment continue.

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Dr. Silvers is medical director and chief of infectious diseases at Eden Medical Center.