Materiały źródłowe

• #1 Clostridioides difficile infection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431054/

  C difficile, formerly known as Clostridium difficile, is a gram-positive and spore-forming bacterium. This obligate anaerobic bacillus is recognized for its ability to produce toxins and cause diarrhea, which is often associated with antibiotic usage. […] The emergence of the newer, hypervirulent, antibiotic-resistant, epidemic strain ribotype 027, also known as the North American pulsed-field gel electrophoresis type 1 (or NAP1) strain has resulted in increased frequency and severity of infections over the last 2 decades. […] C difficile infection ranges from asymptomatic carriage to severe conditions such as pseudomembranous colitis and toxic megacolon, which can lead to fatal outcomes. As a primary cause of healthcare-associated colitis, this bacterium presents a significant public health challenge due to its transmissibility and associated morbidity and mortality.

• #2 Clostridium difficile and the disease it causes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/20597000/

  Clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium abundant in soils and water. Frequent and early colonization of the human intestinal flora is common and often asymptomatic. Antimicrobials given commonly disrupt the intestinal microflora and through proliferation in colon and production of toxin A and B it precipitates C. difficile infection (CDI). […] Infection is acquired from an endogenous source or from spores in the environment, most easily facilitated during hospital stay. In the elderly, comorbidity, hospitalization and antimicrobial treatment present as major risk factors and the slow recolonization of the normal flora likely responsible for single or multiple recurrences of CDI (25-50%) post therapy. […] The current epidemic of the C. difficile strain NAP1/027 emerging in 2002 in Canada and the USA has now spread to most parts of Europe and virulence factors like high toxin production and sporulation challenge the therapeutic situation and cause great concern among infection control workers. Excessive use of modern fluoroquinolones is thought to play an important role in facilitating this epidemic since NAP1/027 was shown to have acquired moxifloxacin resistance compared to historical strains of the same genotype.

• #3 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  Clostridioides difficile (klos-TRID-e-oi-deez dif-uh-SEEL) is a bacterium that causes an infection of the colon, the longest part of the large intestine. […] Illness from C. difficile often occurs after using antibiotic medicines. It mostly affects older adults in hospitals or in long-term care settings. People not in care settings or hospitals also can get C. difficile infection. Some strains of the bacterium that can cause serious infections are more likely to affect younger people. […] C. difficile bacteria enter the body through the mouth. They can begin reproducing in the small intestine. When they reach the part of the large intestine, called the colon, the bacteria can release toxins that damage tissues. These toxins destroy cells and cause watery diarrhea. […] Some people carry C. difficile bacteria in their intestines but never get sick from it. These people are carriers of the bacteria. They can spread infections without being sick.

• #4 Clostridium difficile and the disease it causes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/20597000/

  Clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium abundant in soils and water. Frequent and early colonization of the human intestinal flora is common and often asymptomatic. Antimicrobials given commonly disrupt the intestinal microflora and through proliferation in colon and production of toxin A and B it precipitates C. difficile infection (CDI). […] Infection is acquired from an endogenous source or from spores in the environment, most easily facilitated during hospital stay. In the elderly, comorbidity, hospitalization and antimicrobial treatment present as major risk factors and the slow recolonization of the normal flora likely responsible for single or multiple recurrences of CDI (25-50%) post therapy. […] The current epidemic of the C. difficile strain NAP1/027 emerging in 2002 in Canada and the USA has now spread to most parts of Europe and virulence factors like high toxin production and sporulation challenge the therapeutic situation and cause great concern among infection control workers. Excessive use of modern fluoroquinolones is thought to play an important role in facilitating this epidemic since NAP1/027 was shown to have acquired moxifloxacin resistance compared to historical strains of the same genotype.

• #5 About C. diff | C. diff | CDC

  https://www.cdc.gov/c-diff/about/index.html

  C. diff is a germ that causes diarrhea and colitis (an inflammation of the colon) and can be life-threatening. […] C. diff can affect anyone. Most cases of C. diff infection occur when you’ve been taking antibiotics or not long after you’ve finished the antibiotic course. […] C. diff germs spread from person to person in poop, but the bacteria are often found in the environment. Finding C. diff germs in the home is not unusual, even when no one in the home has been ill with C. diff infection. […] When C. diff germs are outside the body, they become spores. These spores are an inactive form of the germ and have a protective coating allowing them to live for months or years on surfaces and in the soil. The germs become active again when you swallow these spores and they reach the intestines.

• #6 C. difficile infection | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/c-difficile-infection?content_id=CON-20164011

  Clostridioides difficile (klos-TRID-e-oi-deez dif-uh-SEEL) is a bacterium that causes an infection of the colon, the longest part of the large intestine. […] C. difficile bacteria enter the body through the mouth. They can begin reproducing in the small intestine. When they reach the part of the large intestine, called the colon, the bacteria can release toxins that damage tissues. These toxins destroy cells and cause watery diarrhea. […] Some people carry C. difficile bacteria in their intestines but never get sick from it. These people are carriers of the bacteria. They can spread infections without being sick. […] Without enough helpful bacteria to keep it in check, C. difficile can grow out of control quickly. Any antibiotic can cause C. difficile infection. But the antibiotics that most often lead to C. difficile infection include: Clindamycin, Cephalosporins, Penicillins, Fluoroquinolones.

• #7 Clostridioides difficile infection – Wikipedia

  https://en.wikipedia.org/wiki/Clostridioides_difficile_infection

  Causes Clostridioides difficile spread by the fecal-oral route. […] Risk factors for infection include antibiotic or proton pump inhibitor use, hospitalization, hypoalbuminemia, other health problems, and older age. […] Pathogenic C. difficile strains produce multiple toxins. […] Antibiotic treatment of CDIs may be difficult, due both to antibiotic resistance and physiological factors of the bacteria (spore formation, protective effects of the pseudomembrane). […] The emergence of a new and highly toxic strain of C. difficile that is resistant to fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin, said to be causing geographically dispersed outbreaks in North America, was reported in 2005. […] C. difficile is transmitted from person to person by the fecal-oral route.

• #8 Clostridioides difficile infection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431054/

  The most significant risk factor for C difficile infection is broad-spectrum antibiotics. […] Patients can be colonized with C difficile without symptoms, but antibiotic use disturbs the balance of gut flora, enabling C difficile overgrowth and infection. […] The emergence of a newer hypervirulent strain, the North American pulsed-field gel electrophoresis type 1 (NAP1), has been attributed to increased incidence and severity of C difficile infections over the last 2 decades. […] The most significant risk factor for C difficile infection is antibiotic use, particularly broad-spectrum antibiotics. Various antibiotic classes, including penicillins, cephalosporins, fluoroquinolones, and clindamycin, have been associated with the development of the disease.

• #9 Clostridium difficile | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/clostridium-difficile/

  However, strict infection control measures have helped to reduce this risk, and an increasing number of C. difficile infections now occur outside these settings. […] Diarrhoea can be caused by a number of conditions and is a common side effect of antibiotics, so having diarrhoea while taking antibiotics doesn’t necessarily mean you have a C. difficile infection. […] C. difficile bacteria are found in the digestive system of about 1 in every 30 healthy adults. The bacteria often live harmlessly because the other bacteria normally found in the bowel keep it under control. […] However, some antibiotics can interfere with the balance of bacteria in the bowel, which can cause the C. difficile bacteria to multiply and produce toxins that make the person ill. […] When this happens, C. difficile can spread easily to other people because the bacteria are passed out of the body in the person’s diarrhoea.

• #10 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics/print

  Antibiotic-associated diarrhea refers to diarrhea that develops in a person who is taking or recently took antibiotics. One of the most serious causes of antibiotic-associated diarrhea is infection with a bacterium called Clostridioides difficile. C. difficile infections are common, with approximately 500,000 cases per year in the United States. Infection is most common in people who are hospitalized, producing disease in more than 8 hospitalized patients per 1000 (0.9 percent) in 2008 in the United States. […] C. difficile is a disease-causing bacterium that can infect the large bowel and cause colitis. The intestinal tract of normal people contains millions of bacteria, referred to as the „normal flora,” or „normal microbiome” that have a role in protecting the body from infection. Taking antibiotics can kill these „good” bacteria, allowing C. difficile to multiply and release toxins that damage the cells lining the intestinal wall, causing diarrhea, abdominal pain, and fever as well as other symptoms.

• #11 About C. diff | C. diff | CDC

  https://www.cdc.gov/c-diff/about/index.html

  Healthy people don’t get infected often even if the spores reach their intestines. If your immune system is weak or you’ve recently taken antibiotics, you could get sick. Taking antibiotics can affect your microbiome, making you more susceptible to illnesses like C. diff infection. […] A healthy microbiome helps protect you from infection (like C. diff), but antibiotics disrupt your microbiome. Antibiotics that fight bacterial infections by killing bad germs can also get rid of the good germs living in the digestive tract that protect the body against infections. The effect of antibiotics can last as long as several months. If you come in contact with C. diff germs during this time, you can get sick. […] C. diff infection is more common among patients in healthcare settings, such as hospitals and nursing homes. This is because many people carrying C. diff stay or get treated in those facilities.

• #12 C. diff Infections | C. difficile | MedlinePlus

  https://medlineplus.gov/cdiffinfections.html

  C. diff is a bacterium that can cause diarrhea and more serious intestinal conditions such as colitis. It causes close to half a million illnesses each year. […] C. diff bacteria are commonly found in the environment, but people usually only get C. diff infections when they are taking antibiotics. That’s because antibiotics not only wipe out bad germs, but they also kill the good germs that protect your body against infections. The effect of antibiotics can last as long as several months. If you come in contact with C. diff germs during this time, you can get sick. You are more likely to get a C. diff infection if you take antibiotics for more than a week. […] C. diff spreads when people touch food, surfaces, or objects that are contaminated with feces (poop) from a person who has C. diff.

• #13 C. diff: Facts for Clinicians | C. diff | CDC

  https://www.cdc.gov/c-diff/hcp/clinical-overview/index.html

  Clostridioides difficile (C. diff) is a common cause of antibiotic-associated diarrhea (AAD). It accounts for 15 to 25% of all events of AAD. […] C. diff is a spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. […] Antibiotic exposure (especially fluoroquinolones, third or fourth generation cephalosporins, clindamycin, carbapenems) is a risk factor for C. difficile infection. […] C. diff sheds in feces. Any surface, device or material that becomes contaminated with feces could serve as a reservoir for the C. diff spores. […] Patients with CDI exhibit clinical symptoms and test positive for the C. diff organism or its toxin. […] Colonization with C. diff is more common than infection. Colonized patients do not have disease caused by C. diff and often exhibit NO clinical symptoms (asymptomatic) like diarrhea.

• #14 Clostridium difficile infection – NICD

  https://www.nicd.ac.za/diseases-a-z-index/clostridium-difficile-infection/

  Clostridioides difficile infection (CDI) is a leading cause of nosocomial-associated gastrointestinal illness including self-limited diarrhoeal disease, pseudomembranous colitis and fatal toxic megacolon. C. difficile is a Gram-positive, spore-forming anaerobic bacillus. It produces A (enterotoxin) and B (cytoxoin) toxins that cause disease. […] Antibiotic treatment eliminates normal flora but not spores of C. difficile, which then grow in the gastro-intestinal tract and cause disease. C. difficile is often transmitted in hospitals because spores are highly resistant to decontamination.

• #15

  https://link.springer.com/article/10.1007/s10096-019-03539-6

  When the balance of gut microorganisms is disrupted, C. difficilestarts to dominate and colonize the large intestine which might be the first step of infection. […] The pathogen is not invasive, and virulence is mostly due to enzymes, such as collagenase, hyaluronidase, chondroitin-sulfatase, as well as toxins, which damage the epithelial cell cytoskeleton, leading to disruption of tight junctions, fluid secretion, neutrophil adhesion, and local inflammation. […] C. difficileproduces two important in disease pathogenesis types of toxins, A and B, which are both enterotoxic and cytotoxic; however, traditionally, toxin A is named enterotoxin A and toxin B, cytotoxin B. […] The C. difficileBI/NAP1/027 strain is hypervirulent and resistant to fluoroquinolones, exhibits intensive spore production, and is responsible for the most severe CDI cases. […] In the past decade, CDI became one of the most detrimental nosocomial infections.

• #16

  https://link.springer.com/article/10.1007/s10096-019-03539-6

  When the balance of gut microorganisms is disrupted, C. difficilestarts to dominate and colonize the large intestine which might be the first step of infection. […] The pathogen is not invasive, and virulence is mostly due to enzymes, such as collagenase, hyaluronidase, chondroitin-sulfatase, as well as toxins, which damage the epithelial cell cytoskeleton, leading to disruption of tight junctions, fluid secretion, neutrophil adhesion, and local inflammation. […] C. difficileproduces two important in disease pathogenesis types of toxins, A and B, which are both enterotoxic and cytotoxic; however, traditionally, toxin A is named enterotoxin A and toxin B, cytotoxin B. […] The C. difficileBI/NAP1/027 strain is hypervirulent and resistant to fluoroquinolones, exhibits intensive spore production, and is responsible for the most severe CDI cases. […] In the past decade, CDI became one of the most detrimental nosocomial infections.

• #17 C. Difficile (C. diff) | Sepsis Alliance

  https://www.sepsis.org/sepsisand/c-difficile/

  Clostridioides difficile, often called C. difficile or C. diff., is a bacteria spread by microscopic spores. The bacteria cause inflammation of the gut or colon colitis. This can lead to moderate-to-severe diarrhea, and sometimes sepsis, which can develop as the body tries to fight the infection. […] Most C. difficile infections occur in hospitals or healthcare facilities. These are called healthcare-acquired infections, or HAIs. However, physicians are finding that more and more, people are coming into contact with the bacteria in the community. […] People who are in hospitals or other healthcare settings are at highest risk of developing C. difficile infections. Others are those who: Are over 65 years, Have serious illnesses, particularly those that can weaken the immune system, Are taking or who have recently taken antibiotics, Are taking medications to manage stomach acid, including those known as proton pump inhibitors (PPIs), Have had previous C. difficile infections.

• #18 Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection

  https://www.mdpi.com/2076-2607/12/5/1004

  The induction of glycosylation by toxins on Rho/Ras proteins, followed by the redistribution of the actin cytoskeleton, results in dramatic changes in cell morphology. These disruptions include the loss of stress fiber formation, the rounding of cells referred to as the cytopathic effect (CPE), and the contraction of the cellular body leading to the formation of irregular structures. […] The diarrhea caused by CDI is characterized by increased secretion and/or decreased absorption in the gastrointestinal tract. The exchangers SLC9A3 (solute carrier family 9 member A3), also known as sodium-hydrogen exchanger 3 (NHE3), and SLC26A3 (solute carrier family 26 member 3), known as down-regulated in adenoma (DRA), are key ion transporters in the apical region of epithelial cells of the lower gastrointestinal tract. Prolonged TcdA and TcdB exposure significantly decreases NHE3 and DRA levels, leading to dysfunctional water and solute absorption, causing osmotic diarrhea.

• #19 Clostridium difficile Infection: What You Need to Know | Consultant360

  https://www.consultant360.com/article/clostridium-difficile-infection-what-you-need-know

  Clostridium difficile infections are among the most common and most serious healthcare-associated infections in the United States. […] The increase in incidence and mortality is partly attributable to the emergence and spread of the NAP1/BI/027 hyper-virulent resistant strain of C difficile. […] A key factor in the pathogenesis of C difficile infection is the disruption of normal colonic biota (a major host defense system) by antibiotics (or antineoplastic agents with antibacterial activity), which facilitates colonization with toxigenic C difficile. […] The elaboration of toxin A or toxin B (or both) mediates cytoskeletal derangement in target cells, resulting in mucosal injury and inflammation. […] The 2 large exotoxins rank among the most lethal bacterial toxins studied. […] These toxins mediate diarrhea and colitis, and the higher toxin levels are associated with a greater severity of colitis.

• #20 Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection

  https://www.mdpi.com/2076-2607/12/5/1004

  The main virulence factors of C. difficile are TcdA and TcdB, belonging to the family of large clostridial toxins (LCTs). TcdA and TcdB are glucosyltransferases that irreversibly modify the Rho and Ras enzymes associated with guanosine triphosphate (GTPases). The inactivation of regulatory GTPases results in the destruction of the actin cytoskeleton, cell rounding, and ultimately cell detachment. TcdA was termed an enterotoxin due to its ability to induce enterotoxicity in animals, characterized by inflammation, cytokine release, and fluid secretion, while also disrupting tight junctions (TJs) in human intestinal epithelial cells. […] The production of TcdA and TcdB are essential for the pathogenesis of CDI, while TcdB plays a crucial role, as evidenced by strains producing only the TcdB inducing all CDI symptoms, sometimes more severely than strains producing both TcdA and TcdB. Initially, TcdA was considered the primary virulence factor, but subsequent studies showed that both toxins contribute synergistically to disease progression. Recent findings indicate that TcdB is more closely associated with CDI severity, supported by clinical strains predominantly producing TcdB and strains lacking TcdA but causing severe disease.

• #21 Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection

  https://www.mdpi.com/2076-2607/12/5/1004

  CDT was first isolated from strain CD196 (RT 027) from a patient with severe pseudomembranous colitis. It is produced by 5–30% of clinical isolates of C. difficile and is associated with more severe complications, longer hospitalization, and increased mortality rates. The production of CDT has also been correlated with increased antibiotic resistance, and the detection of its gene could be used as a marker for antimicrobial susceptibility. […] CDT consists of two components, CDTa (enzymatic component) and CDTb (binding component). The genes encoding CDT are located in a 6.2 kb genetic region, distinct from the PaLoc, known as the CDT locus or CdtLoc. The CdtLoc includes the genes cdtA and cdtB encoding the components CDTa and CDTb, respectively, and cdtR encoding the protein CdtR. […] Cellular intoxication by CDT occurs in three stages: (i) binding of the toxin to cell surface receptors; (ii) cellular uptake via endocytosis and formation of pores in the endosomal membrane; and (iii) translocation of the toxin into the cytosol and ADP-ribosylation of actin and microtubule protrusion formation.

• #22 Pseudomembranous colitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/symptoms-causes/syc-20351434

  Pseudomembranous colitis is inflammation of the colon associated with an overgrowth of the bacterium Clostridioides difficile (formerly Clostridium difficile) often called C. diff. […] This overgrowth of Clostridioides difficile (C. difficile) is often related to a recent hospital stay or antibiotic treatment. […] Pseudomembranous colitis occurs when certain bacteria, usually C. difficile, rapidly outgrow other bacteria that typically keep them in check. Certain toxins produced by C. difficile can rise to levels high enough to damage the colon. […] While almost any antibiotic can cause pseudomembranous colitis, some antibiotics are more commonly linked to pseudomembranous colitis than others, including: […] Other medicines besides antibiotics can sometimes cause pseudomembranous colitis.

• #23 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Recurrent C. difficile infection is defined by resolution of symptoms during therapy, then reappearance of symptoms two to eight weeks after treatment has ended. The recurrence rate for health care facility-acquired infections is 5% to 50% (median: 20%). […] C. difficile infection is characterized by a wide range of symptoms, from mild or moderate diarrhea to severe disease with pseudomembranous colitis, colonic ileus, toxic megacolon, sepsis, or death. […] The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America recommend limiting testing for C. difficile infection to patients with unexplained onset of three or more unformed stools in 24 hours while not taking laxatives. […] Infection control and good antibiotic stewardship are the cornerstones for reducing the incidence of C. difficile infection in health care and community settings.

• #24 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. […] Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs.

• #25 Clostridium difficile and the disease it causes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/20597000/

  Clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium abundant in soils and water. Frequent and early colonization of the human intestinal flora is common and often asymptomatic. Antimicrobials given commonly disrupt the intestinal microflora and through proliferation in colon and production of toxin A and B it precipitates C. difficile infection (CDI). […] Infection is acquired from an endogenous source or from spores in the environment, most easily facilitated during hospital stay. In the elderly, comorbidity, hospitalization and antimicrobial treatment present as major risk factors and the slow recolonization of the normal flora likely responsible for single or multiple recurrences of CDI (25-50%) post therapy. […] The current epidemic of the C. difficile strain NAP1/027 emerging in 2002 in Canada and the USA has now spread to most parts of Europe and virulence factors like high toxin production and sporulation challenge the therapeutic situation and cause great concern among infection control workers. Excessive use of modern fluoroquinolones is thought to play an important role in facilitating this epidemic since NAP1/027 was shown to have acquired moxifloxacin resistance compared to historical strains of the same genotype.

• #26 Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection

  https://www.mdpi.com/2076-2607/12/5/1004

  The genes encoding TcdA (tcdA) and TcdB (tcdB) are located within the pathogenicity locus (PaLoc) of a 19.6 kb region, which is only found at the same genomic position in toxigenic strains of C. difficile. PaLoc contains four additional open reading frames including the genes tcdR, tcdE, tcdC, and tcdL. Various studies have linked the deletion of the tcdC gene with increased pathogenicity. In the BI/NAP1/027 strain, the deletion of the tcdC gene has been implicated in the production of elevated levels of TcdA and TcdB. […] CDI presents with a spectrum of clinical manifestations from mild diarrhea to severe pseudomembranous colitis, toxic megacolon, and colonic perforation. Various risk factors contribute to CDI, including the administration of broad-spectrum antimicrobials, advanced age, comorbidities, proton pump inhibitor use, prior gastrointestinal surgery, and prolonged hospitalization.

• #27 Clostridioides difficile infection | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19632

  The emergence of the newer, hypervirulent, antibiotic-resistant, epidemic strain ribotype 027, commonly known as NAP1/B1/027 or the North American pulsed-field gel electrophoresis type 1 strain, restriction endonuclease analysis type B1, or polymerase chain reaction ribotype 027 is characterized by increased production of toxins A and B, as well as the production of a binary toxin CDT, and fluoroquinolone resistance. […] The link between antibiotics and the onset of C difficile infections stems from the dysbiosis within the gut microbiome ecosystem induced by antibiotic use. […] C difficile is ubiquitous and can colonize the intestines of up to 3% to 5% of healthy individuals without causing infections. […] Antibiotics alter the microbial balance in the large intestine, increasing susceptibility to C difficile infection, which is transmitted through the fecal-oral route.

• #28 Clostridioides difficile infection | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19632

  The emergence of the newer, hypervirulent, antibiotic-resistant, epidemic strain ribotype 027, commonly known as NAP1/B1/027 or the North American pulsed-field gel electrophoresis type 1 strain, restriction endonuclease analysis type B1, or polymerase chain reaction ribotype 027 is characterized by increased production of toxins A and B, as well as the production of a binary toxin CDT, and fluoroquinolone resistance. […] The link between antibiotics and the onset of C difficile infections stems from the dysbiosis within the gut microbiome ecosystem induced by antibiotic use. […] C difficile is ubiquitous and can colonize the intestines of up to 3% to 5% of healthy individuals without causing infections. […] Antibiotics alter the microbial balance in the large intestine, increasing susceptibility to C difficile infection, which is transmitted through the fecal-oral route.

• #29 Clostridium difficile and the Disease It Causes | Springer Nature Experiments

  https://experiments.springernature.com/articles/10.1007/978-1-60327-365-7_2

  Clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium abundant in soils and water. Frequent and early colonization of the human intestinal flora is common and often asymptomatic. Antimicrobials given commonly disrupt the intestinal microflora and through proliferation in colon and production of toxin A and B it precipitates C. difficile infection (CDI). […] Infection is acquired from an endogenous source or from spores in the environment, most easily facilitated during hospital stay. In the elderly, comorbidity, hospitalization and antimicrobial treatment present as major risk factors and the slow recolonization of the normal flora likely responsible for single or multiple recurrences of CDI (2550%) post therapy. […] Today we experience a tenfold increase of CDI incidence in the western world and both epidemics and therapeutic failure of metronidazole is contributing to morbidity and mortality. The current epidemic of the C. difficile strain NAP1/027 emerging in 2002 in Canada and the USA has now spread to most parts of Europe and virulence factors like high toxin production and sporulation challenge the therapeutic situation and cause great concern among infection control workers. Excessive use of modern fluoroquinolones is thought to play an important role in facilitating this epidemic since NAP1/027 was shown to have acquired moxifloxacin resistance compared to historical strains of the same genotype.

• #30 How to Prevent C. Diff Infection from Recurring

  https://www.healthline.com/health/preventing-c-diff-infection-from-recurring

  Since 2003, C. diff cases have become more frequent, harmful, recurring, and less responsive to treatment. This may be due to the emergence of a severe strain of C. diff known as NAP1/BI/027. […] This specific strain of C. diff produces more toxins than other strains. […] Risk factors such as older age, antibiotic use, gastric acid suppression, and a weakened immune system may increase the likelihood of C. diff recurrence.

• #31 Clostridium difficile and the disease it causes – PubMed

  https://pubmed.ncbi.nlm.nih.gov/20597000/

  Clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium abundant in soils and water. Frequent and early colonization of the human intestinal flora is common and often asymptomatic. Antimicrobials given commonly disrupt the intestinal microflora and through proliferation in colon and production of toxin A and B it precipitates C. difficile infection (CDI). […] Infection is acquired from an endogenous source or from spores in the environment, most easily facilitated during hospital stay. In the elderly, comorbidity, hospitalization and antimicrobial treatment present as major risk factors and the slow recolonization of the normal flora likely responsible for single or multiple recurrences of CDI (25-50%) post therapy. […] The current epidemic of the C. difficile strain NAP1/027 emerging in 2002 in Canada and the USA has now spread to most parts of Europe and virulence factors like high toxin production and sporulation challenge the therapeutic situation and cause great concern among infection control workers. Excessive use of modern fluoroquinolones is thought to play an important role in facilitating this epidemic since NAP1/027 was shown to have acquired moxifloxacin resistance compared to historical strains of the same genotype.

• #32 Clostridium difficile and the Disease It Causes | Springer Nature Experiments

  https://experiments.springernature.com/articles/10.1007/978-1-60327-365-7_2

  Clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium abundant in soils and water. Frequent and early colonization of the human intestinal flora is common and often asymptomatic. Antimicrobials given commonly disrupt the intestinal microflora and through proliferation in colon and production of toxin A and B it precipitates C. difficile infection (CDI). […] Infection is acquired from an endogenous source or from spores in the environment, most easily facilitated during hospital stay. In the elderly, comorbidity, hospitalization and antimicrobial treatment present as major risk factors and the slow recolonization of the normal flora likely responsible for single or multiple recurrences of CDI (2550%) post therapy. […] Today we experience a tenfold increase of CDI incidence in the western world and both epidemics and therapeutic failure of metronidazole is contributing to morbidity and mortality. The current epidemic of the C. difficile strain NAP1/027 emerging in 2002 in Canada and the USA has now spread to most parts of Europe and virulence factors like high toxin production and sporulation challenge the therapeutic situation and cause great concern among infection control workers. Excessive use of modern fluoroquinolones is thought to play an important role in facilitating this epidemic since NAP1/027 was shown to have acquired moxifloxacin resistance compared to historical strains of the same genotype.

• #33 C. diff: Facts for Clinicians | C. diff | CDC

  https://www.cdc.gov/c-diff/hcp/clinical-overview/index.html

  Clostridioides difficile (C. diff) is a common cause of antibiotic-associated diarrhea (AAD). It accounts for 15 to 25% of all events of AAD. […] C. diff is a spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. […] Antibiotic exposure (especially fluoroquinolones, third or fourth generation cephalosporins, clindamycin, carbapenems) is a risk factor for C. difficile infection. […] C. diff sheds in feces. Any surface, device or material that becomes contaminated with feces could serve as a reservoir for the C. diff spores. […] Patients with CDI exhibit clinical symptoms and test positive for the C. diff organism or its toxin. […] Colonization with C. diff is more common than infection. Colonized patients do not have disease caused by C. diff and often exhibit NO clinical symptoms (asymptomatic) like diarrhea.

• #34 Common Questions About Clostridium difficile Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0315/p437.html

  Clostridium difficile infection is a common cause of antibiotic-associated diarrhea. It causes no symptoms in more than one-half of infected patients, but can also cause a wide spectrum of illnesses and death. The most important modifiable risk factor for C. difficile infection is antibiotic exposure; this risk is dose-related and higher with longer courses and combination therapy. C. difficile infection is also associated with older age, recent hospitalization, multiple comorbidities, use of gastric acid blockers, inflammatory bowel disease, and immunosuppression. The incidence and severity of C. difficile infection have increased. The increased incidence and severity are partially due to an epidemic strain, BI/NAP1/027, which produces higher toxin levels and is highly resistant to fluoroquinolones. Risk factors for the development of C. difficile infection include age older than 64 years, recent hospitalization, antibiotic use, multiple comorbidities, use of gastric acid blockers, previous gastrointestinal surgery, inflammatory bowel disease, and immunosuppression. Antibiotic exposure is the most important modifiable risk factor. Although even single doses of prophylactic antibiotics can cause C. difficile infection, greater number of antimicrobials used, greater number of doses, and longer duration of antibiotic administration increase the risk.

• #35 Common Questions About Clostridium difficile Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0315/p437.html

  Clostridium difficile infection is a common cause of antibiotic-associated diarrhea. It causes no symptoms in more than one-half of infected patients, but can also cause a wide spectrum of illnesses and death. The most important modifiable risk factor for C. difficile infection is antibiotic exposure; this risk is dose-related and higher with longer courses and combination therapy. C. difficile infection is also associated with older age, recent hospitalization, multiple comorbidities, use of gastric acid blockers, inflammatory bowel disease, and immunosuppression. The incidence and severity of C. difficile infection have increased. The increased incidence and severity are partially due to an epidemic strain, BI/NAP1/027, which produces higher toxin levels and is highly resistant to fluoroquinolones. Risk factors for the development of C. difficile infection include age older than 64 years, recent hospitalization, antibiotic use, multiple comorbidities, use of gastric acid blockers, previous gastrointestinal surgery, inflammatory bowel disease, and immunosuppression. Antibiotic exposure is the most important modifiable risk factor. Although even single doses of prophylactic antibiotics can cause C. difficile infection, greater number of antimicrobials used, greater number of doses, and longer duration of antibiotic administration increase the risk.

• #36 C. Diff Infection: Symptoms, Causes, Diagnosis and Treatment

  https://www.webmd.com/digestive-disorders/clostridium-difficile-colitis

  C. diff bacteria spread in health care facilities, such as hospitals or nursing homes, where workers are more likely to come into contact with them and then with patients or residents. […] You can also become infected if you touch clothing, sheets, or other surfaces that have come in contact with feces and then touch your mouth or nose. […] […] […] Older adults in health care facilities are most at risk, especially if they’re taking antibiotics. That’s because the human body contains thousands of different types of bacteria — some good, some bad. If the antibiotics kill enough healthy bacteria, the ones that cause C. diff could grow unchecked and make you sick. […] The antibiotics that are most linked to a risk of C. diff infection are: […] Cephalosporins […] Clindamycin

• #37 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  The intestines house a wide range of bacteria. Many of them help protect the body from infection. Antibiotics that treat an infection tend to destroy some of the helpful bacteria in the body as well as the bacteria causing the infection. […] Without enough helpful bacteria to keep it in check, C. difficile can grow out of control quickly. Any antibiotic can cause C. difficile infection. But the antibiotics that most often lead to C. difficile infection include: Clindamycin, Cephalosporins, Penicillins, Fluoroquinolones. […] Taking a proton pump inhibitor, a type of medicine used to cut stomach acid, also may increase the risk of C. difficile infection. […] Most C. difficile infections occur in people who are in or have recently been in health care settings. These include hospitals, nursing homes and long-term care facilities.

• #38 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  The intestines house a wide range of bacteria. Many of them help protect the body from infection. Antibiotics that treat an infection tend to destroy some of the helpful bacteria in the body as well as the bacteria causing the infection. […] Without enough helpful bacteria to keep it in check, C. difficile can grow out of control quickly. Any antibiotic can cause C. difficile infection. But the antibiotics that most often lead to C. difficile infection include: Clindamycin, Cephalosporins, Penicillins, Fluoroquinolones. […] Taking a proton pump inhibitor, a type of medicine used to cut stomach acid, also may increase the risk of C. difficile infection. […] Most C. difficile infections occur in people who are in or have recently been in health care settings. These include hospitals, nursing homes and long-term care facilities.

• #39 Clostridioides (Clostridium) difficile background Clostridioides (Clostridium) difficile Toolkit for Long-term Care Facilities – MN Dept. of Health

  https://www.health.state.mn.us/diseases/cdiff/hcp/ltctoolkit/background.html

  C. difficile, often referred to as C. diff, is a gram positive, anaerobic, spore-forming, toxigenic bacterium that was first recognized as a cause of disease in 1978. […] The severity of C. difficile infections (CDI) ranges from uncomplicated diarrhea to pseudomembranous colitis and toxic megacolon, which can lead to sepsis and death. C. difficile colitis occurs when the gut bacterial equilibrium is disturbed, often by antibiotic use. […] Risk factors for acquiring CDI include exposure to antimicrobial therapy (particularly beta-lactam agents), gastrointestinal procedures, advanced age, immunocompromising conditions, serious underlying illness, long length of stay in health care settings, and indiscriminate use of antimicrobials. […] Antimicrobials most frequently associated with increased risk of C. difficile include third generation cephalosporins, clindamycin, vancomycin, and fluoroquinolones.

• #40 Clostridium difficile: Causes, symptoms, and treatment

  https://www.medicalnewstoday.com/articles/172329

  However, healthcare environments such as hospitals, nursing homes, and long-term healthcare facilities most often host C. difficile. A significant proportion of people staying or living in these settings carry high levels of the bacterium. […] If a person takes antibiotics to treat a different infection, they may destroy some of the helpful bacteria, allowing C. difficile to reproduce more rapidly and dominate the gut. […] Types of antibiotic that may contribute to C. difficile infection include fluoroquinolones, cephalosporins, clindamycin, and penicillin. However, any antibiotic can increase the risk of C. difficile if it decreases the amount of protective bacteria in the gut. […] Once C. difficile reaches the stage of infection, it produces toxins that destroy cells and cause inflammation inside the colon. […] When C. difficile occurs naturally in the gut, people cannot normally pass the infection on to others unless the bacteria start producing toxins.

• #41 C. Diff Infection: Symptoms, Causes, Diagnosis and Treatment

  https://www.webmd.com/digestive-disorders/clostridium-difficile-colitis

  Fluoroquinolones […] Penicillins […] An increasing number of younger people also develop C. diff infections, even without taking antibiotics or being in a hospital. Failure to wash your hands thoroughly after being exposed to the bacteria can lead to infection. […] You also have higher odds of getting C. diff if you have: […] A condition such as colorectal cancer or inflammatory bowel disease […] A weakened immune system caused by cancer treatment or another health problem […] Women have higher chances of getting C. diff than men. You’re also more at risk for the disease if you’re 65 or older. And the more times you’ve had the disease before, the greater your odds of developing C. diff. […] […] […] Clostridioides Difficile (C. Diff) Prevention […] If you’re in a hospital or long-term health care facility, you can do several things to protect yourself from C. diff. For example:

• #42 Clostridioides (formerly Clostridium) difficile–Induced Colitis – Infections – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/infections/bacterial-infections-anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-colitis

  When C. difficile bacteria overgrow, they release toxins that cause diarrhea, colitis, and the formation of abnormal membranes (pseudomembranes) in the large intestine. […] Almost any antibiotic can cause this disorder, but clindamycin, penicillins (such as ampicillin and amoxicillin), cephalosporins (such as ceftriaxone), and fluoroquinolones (such as levofloxacin and ciprofloxacin) are implicated most often. […] C. difficile infection is most common when an antibiotic is taken by mouth, but it also occurs when antibiotics are injected into a muscle or given by vein (intravenously). […] Colitis caused by C. difficile infection rarely occurs unless people have recently used antibiotics. However, physically stressful events, such as surgery (typically involving the stomach or intestine), can likely lead to the same kind of imbalance among the type and quantity of bacteria in the intestine or can interfere with the intestine’s intrinsic defense mechanisms, which, in turn, allows C. difficile infection and colitis to develop.

• #43 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  The intestines house a wide range of bacteria. Many of them help protect the body from infection. Antibiotics that treat an infection tend to destroy some of the helpful bacteria in the body as well as the bacteria causing the infection. […] Without enough helpful bacteria to keep it in check, C. difficile can grow out of control quickly. Any antibiotic can cause C. difficile infection. But the antibiotics that most often lead to C. difficile infection include: Clindamycin, Cephalosporins, Penicillins, Fluoroquinolones. […] Taking a proton pump inhibitor, a type of medicine used to cut stomach acid, also may increase the risk of C. difficile infection. […] Most C. difficile infections occur in people who are in or have recently been in health care settings. These include hospitals, nursing homes and long-term care facilities.

• #44 C. diff: Facts for Clinicians | C. diff | CDC

  https://www.cdc.gov/c-diff/hcp/clinical-overview/index.html

  Clostridioides difficile (C. diff) is a common cause of antibiotic-associated diarrhea (AAD). It accounts for 15 to 25% of all events of AAD. […] C. diff is a spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. […] Antibiotic exposure (especially fluoroquinolones, third or fourth generation cephalosporins, clindamycin, carbapenems) is a risk factor for C. difficile infection. […] C. diff sheds in feces. Any surface, device or material that becomes contaminated with feces could serve as a reservoir for the C. diff spores. […] Patients with CDI exhibit clinical symptoms and test positive for the C. diff organism or its toxin. […] Colonization with C. diff is more common than infection. Colonized patients do not have disease caused by C. diff and often exhibit NO clinical symptoms (asymptomatic) like diarrhea.

• #45 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  C. difficile is the most commonly recognized cause of infectious diarrhea in healthcare settings. […] The emergence of the virulent, epidemic ribotype 027 strain was associated with increased incidence, severity, and mortality during the mid-2000s and resulted in outbreaks across North America. […] The recent isolates of the 027 strain are more highly resistant to fluoroquinolones compared to historic strains of the same type. […] The risk of CDI increases with the length of stay, the most appropriate denominator for HO-CDI rates is the number of patient-days. […] The most important modifiable risk factor for the development of CDI is exposure to antibiotic agents. […] The disruption of the intestinal microbiota by antibiotics is long-lasting, and risk of CDI increases both during therapy and in the 3-month period following cessation of therapy. […] Advanced age, potentially as a surrogate for severity of illness and comorbidities, is one of the most important risk factors for CDI. […] The potential role of asymptomatically colonized patients in transmission has recently been highlighted.

• #46 What Is C. Diff? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/c-diff/guide/

  Yet in people with weakened immune systems or recent antibiotic use, for example, C. diff can lead to illness from the release of toxins that attack the lining of the organ. […] Although people with no known risk factors can get a C. diff infection, certain things increase your risk, including the heavy use of antibiotics for the treatment of long-term infections. These antibiotics can disrupt the normal makeup of the gut microbiome the community of microbes living in the intestines allowing C. diff to grow out of control and cause an infection. […] Risk factors also include older age, having a severe underlying disease such as inflammatory bowel disease (IBD) or colorectal cancer, or having a weakened immune system. […] In addition, the use of proton pump inhibitors (PPIs), a type of medicine that reduces stomach acid and treats acid reflux, also may increase your risk of C. diff infection. […] Most C. diff infections occur in people who are or who have recently been in healthcare facilities such as hospitals, nursing homes, and rehabilitation centers. In these facilities, germs spread easily, antibiotic use is common, and patients are particularly vulnerable to infection.

• #47 Clostridium difficile

  https://mobile.fpnotebook.com/GI/ID/ClstrdmDfcl.htm

  First recognized in 1978 as a cause of Antibiotic-Associated Diarrhea in 1978 […] Clostridium difficile was reclassified as Clostridioides difficile in 2016. […] Causes Secretory Diarrhea and mucosal injury with colitis. […] Two toxins are typically produced: Enterotoxin A (accompanies Toxin B in some cases) and Cytotoxin B (present in all cases). […] New virulent epidemic strain: NAP1/B1/027. […] Strain responsible for the 5 fold increase in C. difficile infections from 1999 to 2007. […] C. difficile is acquired in health care settings in 94% of cases. […] Colonization occurs in 7 to 26% of acute care facilities. […] Colonization risk increases for each day of hospitalization. […] Colonization is community acquired in 41% of cases. […] Up to 15% of healthy adults are colonized with C difficile.

• #48 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  The intestines house a wide range of bacteria. Many of them help protect the body from infection. Antibiotics that treat an infection tend to destroy some of the helpful bacteria in the body as well as the bacteria causing the infection. […] Without enough helpful bacteria to keep it in check, C. difficile can grow out of control quickly. Any antibiotic can cause C. difficile infection. But the antibiotics that most often lead to C. difficile infection include: Clindamycin, Cephalosporins, Penicillins, Fluoroquinolones. […] Taking a proton pump inhibitor, a type of medicine used to cut stomach acid, also may increase the risk of C. difficile infection. […] Most C. difficile infections occur in people who are in or have recently been in health care settings. These include hospitals, nursing homes and long-term care facilities.

• #49 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  Advanced age (65 y) and hospitalization (particularly sharing a hospital room with an infected patient, intensive care unit stays, and prolonged hospital stays) are known risk factors for infection with C difficile, as are comorbidities such as kidney disease, liver disease, and cardiovascular disease. […] Risk factors for recurrence of CDI include age older than 65 years, immune compromise, severe underlying illnesses, ongoing antibiotic treatments during CDI, and severe CDI on presentation. […] Ultimately, many of the genetic influences on CDI and the clinical course of C difficile colitis likely remain unknown.

• #50 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics/print

  C. difficile infections have become more frequent, more severe, more difficult to treat, and more likely to recur after initial treatment. Although most people become infected with C. difficile in the hospital, community-acquired infection in patients who have not been hospitalized has also become more common. Community-acquired C. difficile infection can develop in the absence of any recent antibiotic use. […] A number of factors can increase a person’s risk of becoming infected with C. difficile: Current or recent antibiotic use – Certain antibiotics increase the risk of becoming infected with C. difficile more than others. Current or recent hospitalization – Up to 20 percent of people who are hospitalized and up to 50 percent of people in long-term care facilities (eg, nursing homes) carry C. difficile in their feces, but many do not have diarrhea or other symptoms. Exposure to these carriers significantly increases a person’s risk of becoming infected. Older age – The risk of becoming infected with C. difficile is 10 times greater in people who are 65 years or older. Severe illness – People who have a weakened immune system as a result of an underlying medical condition or a treatment (eg, chemotherapy) are at increased risk of becoming infected with C. difficile, especially during a hospital stay. Recent infection with C. difficile – People who have been recently infected with C. difficile and treated have an increased risk of becoming infected again soon after stopping the treatment. Inflammatory bowel disease (ulcerative colitis or Crohn’s disease with colitis) – People with colitis from inflammatory bowel disease have an increased risk of developing C. difficile infection. In this circumstance, C. difficile infection may develop in the absence of prior antibiotic treatment.

• #51 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  C difficile colitis results from a disruption of the normal bacterial flora of the colon, colonization with C difficile, and release of toxins that cause mucosal inflammation, mucosal damage, and diarrhea. […] The primary risk factor for C difficile colitis is previous exposure to antibiotics; the most commonly implicated agents include the cephalosporins (especially second and third generation), the fluoroquinolones, ampicillin/amoxicillin, and clindamycin. […] Even brief exposure to any single antibiotic can cause C difficile colitis. A prolonged antibiotic course or the use of two or more antibiotics increases the risk of disease. […] Hospitalized patients who occupy a bed whose previous occupant received antibiotics appear to have an increased risk of CDI. […] A US Food and Drug Administration (FDA) safety communication on February 8, 2012, described a possible association between the use of proton pump inhibitors (PPIs) and the development of Clostridium difficile associated diarrhea (CDAD).

• #52 Clostridioides difficile infection – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431054/

  Incomplete infection control and antibiotic stewardship practices in healthcare institutions allow C difficile transmission among patients. […] C difficile produces 2 types of toxins A and B which are virulent factors in its pathogenicity. Most pathogenic strains associated with C difficile infection produce toxins A and B. […] The emergence of the newer, hypervirulent, antibiotic-resistant, epidemic strain ribotype 027, commonly known as NAP1/B1/027 or the North American pulsed-field gel electrophoresis type 1 strain, is characterized by increased production of toxins A and B, as well as the production of a binary toxin CDT, and fluoroquinolone resistance.

• #53 C. diff: Facts for Clinicians | C. diff | CDC

  https://www.cdc.gov/c-diff/hcp/clinical-overview/index.html

  Clostridioides difficile (C. diff) is a common cause of antibiotic-associated diarrhea (AAD). It accounts for 15 to 25% of all events of AAD. […] C. diff is a spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. […] Antibiotic exposure (especially fluoroquinolones, third or fourth generation cephalosporins, clindamycin, carbapenems) is a risk factor for C. difficile infection. […] C. diff sheds in feces. Any surface, device or material that becomes contaminated with feces could serve as a reservoir for the C. diff spores. […] Patients with CDI exhibit clinical symptoms and test positive for the C. diff organism or its toxin. […] Colonization with C. diff is more common than infection. Colonized patients do not have disease caused by C. diff and often exhibit NO clinical symptoms (asymptomatic) like diarrhea.

• #54 Clostridium difficile

  https://mobile.fpnotebook.com/GI/ID/ClstrdmDfcl.htm

  First recognized in 1978 as a cause of Antibiotic-Associated Diarrhea in 1978 […] Clostridium difficile was reclassified as Clostridioides difficile in 2016. […] Causes Secretory Diarrhea and mucosal injury with colitis. […] Two toxins are typically produced: Enterotoxin A (accompanies Toxin B in some cases) and Cytotoxin B (present in all cases). […] New virulent epidemic strain: NAP1/B1/027. […] Strain responsible for the 5 fold increase in C. difficile infections from 1999 to 2007. […] C. difficile is acquired in health care settings in 94% of cases. […] Colonization occurs in 7 to 26% of acute care facilities. […] Colonization risk increases for each day of hospitalization. […] Colonization is community acquired in 41% of cases. […] Up to 15% of healthy adults are colonized with C difficile.

• #55 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  Advanced age (65 y) and hospitalization (particularly sharing a hospital room with an infected patient, intensive care unit stays, and prolonged hospital stays) are known risk factors for infection with C difficile, as are comorbidities such as kidney disease, liver disease, and cardiovascular disease. […] Risk factors for recurrence of CDI include age older than 65 years, immune compromise, severe underlying illnesses, ongoing antibiotic treatments during CDI, and severe CDI on presentation. […] Ultimately, many of the genetic influences on CDI and the clinical course of C difficile colitis likely remain unknown.

• #56 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  Certain medical conditions or procedures can up the risk of getting a C. difficile infection, including: Inflammatory bowel disease, Weakened immune system from a medical condition or treatment such as chemotherapy, Chronic kidney disease, Procedures on the digestive tract, Other surgery of the stomach area. […] Older age is a risk factor. In one study, the risk of becoming infected with C. difficile was 10 times greater for people age 65 and older compared with younger people. […] Having one C. difficile infection increases the chance of having another one. The risk increases with each infection.

• #57 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics/print

  C. difficile infections have become more frequent, more severe, more difficult to treat, and more likely to recur after initial treatment. Although most people become infected with C. difficile in the hospital, community-acquired infection in patients who have not been hospitalized has also become more common. Community-acquired C. difficile infection can develop in the absence of any recent antibiotic use. […] A number of factors can increase a person’s risk of becoming infected with C. difficile: Current or recent antibiotic use – Certain antibiotics increase the risk of becoming infected with C. difficile more than others. Current or recent hospitalization – Up to 20 percent of people who are hospitalized and up to 50 percent of people in long-term care facilities (eg, nursing homes) carry C. difficile in their feces, but many do not have diarrhea or other symptoms. Exposure to these carriers significantly increases a person’s risk of becoming infected. Older age – The risk of becoming infected with C. difficile is 10 times greater in people who are 65 years or older. Severe illness – People who have a weakened immune system as a result of an underlying medical condition or a treatment (eg, chemotherapy) are at increased risk of becoming infected with C. difficile, especially during a hospital stay. Recent infection with C. difficile – People who have been recently infected with C. difficile and treated have an increased risk of becoming infected again soon after stopping the treatment. Inflammatory bowel disease (ulcerative colitis or Crohn’s disease with colitis) – People with colitis from inflammatory bowel disease have an increased risk of developing C. difficile infection. In this circumstance, C. difficile infection may develop in the absence of prior antibiotic treatment.

• #58 C. Difficile Causes, Symptoms, and Treatments | UPMC

  https://www.upmc.com/services/division-infectious-diseases/conditions/clostridioides-difficile

  Risk factors of C. diff include: Being age 65 or older. Having a weakened immune system. Solid organ or bone marrow transplants, HIV/AIDS, or certain medicines can weaken your immune system. Having had a past infection of C. diff. Having certain chronic health issues, such as cancer, kidney disease, or inflammatory bowel disease. Staying in a hospital or nursing home. Having had a recent surgery in the digestive system. Taking medicines called proton pump inhibitors to treat problems from stomach acid. […] Without treatment, C. diff can cause severe problems or even death. […] C. diff can also recur despite a good first response to the anti-C. diff therapy. […] C. diff returns in about one in six people, usually within the two to eight weeks after stopping anti-C. diff therapy. But it can take as long as three months to come back.

• #59 C. Diff: What It Is, Causes, Symptoms & Treatment

  https://www.healthday.com/a-to-z-health/infectious-disease/c-diff-2666033931.html

  People with health conditions that affect the immune system, such as cancer or HIV, are also at increased risk for C. diff infection. The CDC says the same is true for anyone taking immunosuppressant drugs. […] One in 6 people who have had a C. diff infection in the last two to eight weeks will be reinfected, according to the CDC. […] Yes, C. diff bacteria is contagious. StatPearls says it’s primarily transmitted by contact with fecal matter that gets into the mouth and then the digestive system.

• #60 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  Certain medical conditions or procedures can up the risk of getting a C. difficile infection, including: Inflammatory bowel disease, Weakened immune system from a medical condition or treatment such as chemotherapy, Chronic kidney disease, Procedures on the digestive tract, Other surgery of the stomach area. […] Older age is a risk factor. In one study, the risk of becoming infected with C. difficile was 10 times greater for people age 65 and older compared with younger people. […] Having one C. difficile infection increases the chance of having another one. The risk increases with each infection.

• #61 C. difficile infection | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/c-difficile-infection?content_id=CON-20164011

  Most C. difficile infections occur in people who are in or have recently been in health care settings. These include hospitals, nursing homes and long-term care facilities. […] Certain medical conditions or procedures can up the risk of getting a C. difficile infection, including: Inflammatory bowel disease, Weakened immune system from a medical condition or treatment such as chemotherapy, Chronic kidney disease, Procedures on the digestive tract, Other surgery of the stomach area. […] Having one C. difficile infection increases the chance of having another one. The risk increases with each infection.

• #62 Clostridioides difficile infection – Wikipedia

  https://en.wikipedia.org/wiki/Clostridioides_difficile_infection

  People with a recent history of diarrheal illness are at increased risk of becoming colonized by C. difficile when exposed to spores, including laxative abuse and gastrointestinal pathogens. […] Chronic kidney disease (CKD) has been identified as a risk factor in the development of a C. difficile infection. […] The use of systemic antibiotics, including broad-spectrum penicillins/cephalosporins, fluoroquinolones, and clindamycin, causes the normal microbiota of the bowel to be altered. […] Without either toxin A or toxin B, C. difficile may colonize the gut, but is unlikely to cause pseudomembranous colitis.

• #63 C. difficile infection | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/c-difficile-infection?content_id=CON-20164011

  Most C. difficile infections occur in people who are in or have recently been in health care settings. These include hospitals, nursing homes and long-term care facilities. […] Certain medical conditions or procedures can up the risk of getting a C. difficile infection, including: Inflammatory bowel disease, Weakened immune system from a medical condition or treatment such as chemotherapy, Chronic kidney disease, Procedures on the digestive tract, Other surgery of the stomach area. […] Having one C. difficile infection increases the chance of having another one. The risk increases with each infection.

• #64 C. Diff Infection: Symptoms, Causes, Diagnosis and Treatment

  https://www.webmd.com/digestive-disorders/clostridium-difficile-colitis

  Fluoroquinolones […] Penicillins […] An increasing number of younger people also develop C. diff infections, even without taking antibiotics or being in a hospital. Failure to wash your hands thoroughly after being exposed to the bacteria can lead to infection. […] You also have higher odds of getting C. diff if you have: […] A condition such as colorectal cancer or inflammatory bowel disease […] A weakened immune system caused by cancer treatment or another health problem […] Women have higher chances of getting C. diff than men. You’re also more at risk for the disease if you’re 65 or older. And the more times you’ve had the disease before, the greater your odds of developing C. diff. […] […] […] Clostridioides Difficile (C. Diff) Prevention […] If you’re in a hospital or long-term health care facility, you can do several things to protect yourself from C. diff. For example:

• #65 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  Certain medical conditions or procedures can up the risk of getting a C. difficile infection, including: Inflammatory bowel disease, Weakened immune system from a medical condition or treatment such as chemotherapy, Chronic kidney disease, Procedures on the digestive tract, Other surgery of the stomach area. […] Older age is a risk factor. In one study, the risk of becoming infected with C. difficile was 10 times greater for people age 65 and older compared with younger people. […] Having one C. difficile infection increases the chance of having another one. The risk increases with each infection.

• #66 C diff (Clostridium difficile) Infection – familydoctor.org

  https://familydoctor.org/condition/clostridium-difficile-c-diff-infection/

  People who are 65 years of age or older are at greater risk of a C. diff. infection. Other risk factors include: Surgery of the gastrointestinal (GI) tract. Stomach surgery that requires moving the intestines aside. A stay in the hospital. Living in a nursing home or extended-care facility. Colon problems, such as inflammatory bowel syndrome (IBS) or colorectal cancer. Weakened immune system. Prior C. diff infection. […] If you are in good health, you likely will not get a C. diff. infection.

• #67 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Antibiotic use is the most widely recognized risk factor for C. difficile infection, and longer courses further increase the risk. Any antimicrobial agent can cause C. difficile infection, but clindamycin is the most common. Other risk factors include severe illness, being older than 70 years, gastric acid suppression, enteral feeding, gastrointestinal surgery, small bowel obstruction, obesity, hematopoietic stem cell and solid organ transplantation, inflammatory bowel disease, cirrhosis, being peripartum, chronic kidney disease, hyperglycemia, hypoalbuminemia, and leukocytosis. […] A recent retrospective cohort study of adults with C. difficile infection in the Veterans Health Administration found that 60% of cases were diagnosed after more than two days of hospitalization; these were classified as health care facility-acquired infections. The remaining 40% were community-acquired infections, and on average 62% of these were associated with antibiotic use.

• #68 What Is C. diff? Symptoms, Causes, and Treatments Explained – BuzzRx

  https://www.buzzrx.com/blog/what-is-c-diff

  Other known risk factors for C. difficile infections are healthcare settings, such as hospitals, long-term care facilities, and nursing homes. These are places where antibiotic use is common, and germs can spread easily. […] However, C. difficile infections can also occur without antibiotic use and outside hospitals and care settings. Some strains of the bacteria that can cause serious infections are more likely to infect younger people. […] The risk increases with each subsequent infection. People who have had three or more C. difficile infections have a more than 50% risk of having another one. […] C. diff germs are mainly transmitted from feces (stool) to the mouth. After the bacteria enter the body through the mouth, they start multiplying in the small intestine. When they reach the colon (large intestine), they release toxins and cause damage, resulting in severe diarrhea.

• #69 C. difficile infection | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/c-difficile-infection?content_id=CON-20164011

  Most C. difficile infections occur in people who are in or have recently been in health care settings. These include hospitals, nursing homes and long-term care facilities. […] Certain medical conditions or procedures can up the risk of getting a C. difficile infection, including: Inflammatory bowel disease, Weakened immune system from a medical condition or treatment such as chemotherapy, Chronic kidney disease, Procedures on the digestive tract, Other surgery of the stomach area. […] Having one C. difficile infection increases the chance of having another one. The risk increases with each infection.

• #70 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  The intestines house a wide range of bacteria. Many of them help protect the body from infection. Antibiotics that treat an infection tend to destroy some of the helpful bacteria in the body as well as the bacteria causing the infection. […] Without enough helpful bacteria to keep it in check, C. difficile can grow out of control quickly. Any antibiotic can cause C. difficile infection. But the antibiotics that most often lead to C. difficile infection include: Clindamycin, Cephalosporins, Penicillins, Fluoroquinolones. […] Taking a proton pump inhibitor, a type of medicine used to cut stomach acid, also may increase the risk of C. difficile infection. […] Most C. difficile infections occur in people who are in or have recently been in health care settings. These include hospitals, nursing homes and long-term care facilities.

• #71 Fact Sheet – Clostridium difficile (C. difficile) – Canada.ca

  https://www.canada.ca/en/public-health/services/infectious-diseases/fact-sheet-clostridium-difficile-difficile.html

  The presence of C. difficile bacteria, together with a large number of patients receiving antibiotics in healthcare settings, can lead to frequent C. difficile outbreaks. […] People in healthcare settings are most at risk of acquiring this type of infection because C. difficile is often a healthcare-associated infection. […] Those at higher risk include the elderly, people with severe underlying illness, and people taking certain antibiotics (especially over a prolonged period of time) or cancer chemotherapy. In addition, patients taking stomach ulcer drugs, known as proton pump inhibitors, are at increased risk for contracting C. difficile infection.

• #72 What Is C. Diff? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/c-diff/guide/

  Yet in people with weakened immune systems or recent antibiotic use, for example, C. diff can lead to illness from the release of toxins that attack the lining of the organ. […] Although people with no known risk factors can get a C. diff infection, certain things increase your risk, including the heavy use of antibiotics for the treatment of long-term infections. These antibiotics can disrupt the normal makeup of the gut microbiome the community of microbes living in the intestines allowing C. diff to grow out of control and cause an infection. […] Risk factors also include older age, having a severe underlying disease such as inflammatory bowel disease (IBD) or colorectal cancer, or having a weakened immune system. […] In addition, the use of proton pump inhibitors (PPIs), a type of medicine that reduces stomach acid and treats acid reflux, also may increase your risk of C. diff infection. […] Most C. diff infections occur in people who are or who have recently been in healthcare facilities such as hospitals, nursing homes, and rehabilitation centers. In these facilities, germs spread easily, antibiotic use is common, and patients are particularly vulnerable to infection.

• #73 Clostridium Difficile (C. Diff): Severe Diarrhea Treatment, Symptoms & Tests

  https://www.emedicinehealth.com/clostridium_difficile_c_difficile_c_diff/article_em.htm

  Although any antibiotic is a potential risk factor for C. diff infection, the ones most commonly recognized are: clindamycin, fluoroquinolones, penicillins, and cephalosporins. […] Other risk factors for C. diff infection include hospitalization, age greater than 65 years, the presence of chronic medical conditions, and severe illness. […] Another possible additional risk factor is the suppression of gastric acid.

• #74

  https://link.springer.com/article/10.1007/s10096-019-03539-6

  Clostridium difficile (C. difficile) is a Gram-positive, spore-forming, anaerobic bacillus, which is widely distributed in the intestinal tract of humans and animals and in the environment. […] Transmission of this pathogen occurs by the fecal-oral route and the most important risk factors include antibiotic therapy, old age, and hospital or nursing home stay. […] Significant patient-related risk factors for CDI are antibiotic exposure, older age, and hospitalization. Nearly every antibiotic has been associated with the development of CDI, including the drugs used for treatment of CDI: metronidazole and vancomycin. […] The main protective barrier against CDI is the normal intestinal microflora. After reaching the intestine, bile acids play an important role in the induction ofC. difficilespore germination.

• #75 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  C difficile colitis results from a disruption of the normal bacterial flora of the colon, colonization with C difficile, and release of toxins that cause mucosal inflammation, mucosal damage, and diarrhea. […] The primary risk factor for C difficile colitis is previous exposure to antibiotics; the most commonly implicated agents include the cephalosporins (especially second and third generation), the fluoroquinolones, ampicillin/amoxicillin, and clindamycin. […] Even brief exposure to any single antibiotic can cause C difficile colitis. A prolonged antibiotic course or the use of two or more antibiotics increases the risk of disease. […] Hospitalized patients who occupy a bed whose previous occupant received antibiotics appear to have an increased risk of CDI. […] A US Food and Drug Administration (FDA) safety communication on February 8, 2012, described a possible association between the use of proton pump inhibitors (PPIs) and the development of Clostridium difficile associated diarrhea (CDAD).

• #76 Clostridioides difficile infection – Wikipedia

  https://en.wikipedia.org/wiki/Clostridioides_difficile_infection

  Causes Clostridioides difficile spread by the fecal-oral route. […] Risk factors for infection include antibiotic or proton pump inhibitor use, hospitalization, hypoalbuminemia, other health problems, and older age. […] Pathogenic C. difficile strains produce multiple toxins. […] Antibiotic treatment of CDIs may be difficult, due both to antibiotic resistance and physiological factors of the bacteria (spore formation, protective effects of the pseudomembrane). […] The emergence of a new and highly toxic strain of C. difficile that is resistant to fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin, said to be causing geographically dispersed outbreaks in North America, was reported in 2005. […] C. difficile is transmitted from person to person by the fecal-oral route.

• #77 Clostridioides difficile infections (C. diff, CDI) | Disease Outbreak Control Division

  https://health.hawaii.gov/docd/disease_listing/clostridium-difficile-infections-c-diff-cdi/

  Clostridioides difficile is a bacterium that causes diarrhea and inflammation of colon, known as colitis. People who have other illnesses or conditions requiring prolonged use of antibiotics, and the elderly, are at greater risk of acquiring this disease. […] C. difficile can be found in feces of those who are sick with C. difficile infections (CDI). People can become infected if they touch items or surfaces that are contaminated with feces and then touch their mouth or mucous membranes. Healthcare workers can spread the bacteria to patients or contaminate surfaces through hand contact. […] C. difficile is shed in feces or stool. Any surface, device, or material (e.g., toilets, bathing tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the C. difficile spores. C. difficile spores are transferred to patients mainly via the hands of healthcare personnel and visitors who have touched a contaminated surface or item. C. difficile can live for long periods on surfaces.

• #78 C. Diff Infection: Symptoms, Causes, Diagnosis and Treatment

  https://www.webmd.com/digestive-disorders/clostridium-difficile-colitis

  Clostridioides Difficile Causes […] C. diff exists all around us. It’s in the air, water, soil, and the feces of humans and animals. […] Clostridium difficile (C. diff) is a highly contagious bacterial infection of the colon. It’s typically caused by taking certain antibiotics, which can interfere with the balance between good and bad bacteria in your gut. […] C. diff bacteria that are outside the body turn into spores that can live on surfaces for weeks or months. These spores are not „active,” but they can turn active after you swallow them and they get into your intestines. Some people have the bacteria in their intestines and never have any symptoms. But for others, the bacteria make toxins that attack the intestines. […] A new strain of C. diff bacteria makes larger amounts of toxins. These types are hard to treat with medications.

• #79 Clostridium difficile (C. diff ) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/c-diff-infection

  People are seven to 10 times more likely to get C. diff while taking antibiotics and for up to one month after, according to the CDC. For some people, an infection may occur several months after completing a course of antibiotics. […] Also, C. diff bacteria can survive for months and arent easily eradicated by all disinfectants (including alcohol-based hand sanitizers). Only cleaners such as bleach can kill the spores. […] C. diff is treated with the very thing that most often causes itantibiotics. However, if you contract C. diff while on antibiotics, your doctor will likely have you stop the medication you are taking and try a different type. […] Unfortunately, C. diff reinfection is fairly common, occurring in about 20 percent of patients. For those patients, a stronger type of antibiotic may be necessary, or a fecal transplant (using stool transferred from a healthy patient). This method, says Matthew Grant, MD, a Yale Medicine infectious diseases specialist, is often more effective than antibiotics.

• #80 Clostridium difficile | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/clostridium-difficile/

  Once out of the body, the bacteria turn into resistant cells called spores. These can survive for long periods on hands, surfaces (such as toilets), objects and clothing unless they’re thoroughly cleaned, and can infect someone else if they get into their mouth. […] Someone with a C. difficile infection is generally considered to be infectious until at least 48 hours after their symptoms have cleared up.

• #81 C. diff: Facts for Clinicians | C. diff | CDC

  https://www.cdc.gov/c-diff/hcp/clinical-overview/index.html

  If CDI is confirmed: Use antibiotics appropriately. […] In about 20% of patients, CDI will resolve within two to three days of discontinuing the antibiotic to which the patient was previously exposed. However, CDI should usually be treated with an appropriate course (about 10 days) of treatment, including oral vancomycin or fidaxomicin. […] EPA-registered disinfectants with a sporicidal claim have been successful in environmental surface disinfection of patient-care areas where surveillance and epidemiology indicate ongoing transmission of C. diff. […] C. diff is a germ that causes diarrhea and colitis (inflammation of the colon). It can be life-threatening.

• #82 About C. diff | C. diff | CDC

  https://www.cdc.gov/c-diff/about/index.html

  Healthy people don’t get infected often even if the spores reach their intestines. If your immune system is weak or you’ve recently taken antibiotics, you could get sick. Taking antibiotics can affect your microbiome, making you more susceptible to illnesses like C. diff infection. […] A healthy microbiome helps protect you from infection (like C. diff), but antibiotics disrupt your microbiome. Antibiotics that fight bacterial infections by killing bad germs can also get rid of the good germs living in the digestive tract that protect the body against infections. The effect of antibiotics can last as long as several months. If you come in contact with C. diff germs during this time, you can get sick. […] C. diff infection is more common among patients in healthcare settings, such as hospitals and nursing homes. This is because many people carrying C. diff stay or get treated in those facilities.

• #83 Clostridioides difficile infections (C. diff, CDI) | Disease Outbreak Control Division

  https://health.hawaii.gov/docd/disease_listing/clostridium-difficile-infections-c-diff-cdi/

  Clostridioides difficile is a bacterium that causes diarrhea and inflammation of colon, known as colitis. People who have other illnesses or conditions requiring prolonged use of antibiotics, and the elderly, are at greater risk of acquiring this disease. […] C. difficile can be found in feces of those who are sick with C. difficile infections (CDI). People can become infected if they touch items or surfaces that are contaminated with feces and then touch their mouth or mucous membranes. Healthcare workers can spread the bacteria to patients or contaminate surfaces through hand contact. […] C. difficile is shed in feces or stool. Any surface, device, or material (e.g., toilets, bathing tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the C. difficile spores. C. difficile spores are transferred to patients mainly via the hands of healthcare personnel and visitors who have touched a contaminated surface or item. C. difficile can live for long periods on surfaces.

• #84 Pseudomembranous colitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/symptoms-causes/syc-20351434

  C. difficile spores are resistant to many common disinfectants and can be transmitted from the hands of health care professionals to patients. […] More and more often, C. difficile is being reported in people with no known risk factors, including people with no recent health care contact or use of antibiotics. This is called community-acquired C. difficile. […] An aggressive strain of C. difficile has emerged that produces far more toxins than other strains do. The new strain may be more resistant to certain medicines and has been reported in people who haven’t been in the hospital or taken antibiotics.

• #85 Clostridium difficile | Health | Province of Manitoba

  https://www.gov.mb.ca/health/publichealth/diseases/cdi.html

  Clostridium Difficile, commonly called C. difficile, is a bacterium found in feces that causes mild to severe diarrhea and other serious intestinal illnesses. C. difficile is one of the most common causes of infectious diarrhea in hospitals or long-term care homes. […] People can become infected with C. difficile if they touch surfaces such as toilets, bedpans or commode chairs that are contaminated with feces, and then touch their mouths. Health care workers can spread the bacteria to their patients if their hands are contaminated and they do not follow proper hand hygiene. Using antibiotics increases the chance of developing C. difficile. Antibiotics can destroy a person’s good bowel bacteria, which allow C. difficile to grow. When this happens, the C. difficile bacteria produce toxins which can damage the bowel and cause diarrhea. Some people can have C. difficile bacteria present in their bowel and not show any symptoms. Healthy people usually are not at risk of serious illness, but the elderly and those with other illnesses, who are taking antibiotics, are at greater risk of infection.

• #86 C. Diff Infection: Symptoms, Causes, Diagnosis and Treatment

  https://www.webmd.com/digestive-disorders/clostridium-difficile-colitis

  C. diff bacteria spread in health care facilities, such as hospitals or nursing homes, where workers are more likely to come into contact with them and then with patients or residents. […] You can also become infected if you touch clothing, sheets, or other surfaces that have come in contact with feces and then touch your mouth or nose. […] […] […] Older adults in health care facilities are most at risk, especially if they’re taking antibiotics. That’s because the human body contains thousands of different types of bacteria — some good, some bad. If the antibiotics kill enough healthy bacteria, the ones that cause C. diff could grow unchecked and make you sick. […] The antibiotics that are most linked to a risk of C. diff infection are: […] Cephalosporins […] Clindamycin

• #87 Clostridium difficile | Health | Province of Manitoba

  https://www.gov.mb.ca/health/publichealth/diseases/cdi.html

  Clostridium Difficile, commonly called C. difficile, is a bacterium found in feces that causes mild to severe diarrhea and other serious intestinal illnesses. C. difficile is one of the most common causes of infectious diarrhea in hospitals or long-term care homes. […] People can become infected with C. difficile if they touch surfaces such as toilets, bedpans or commode chairs that are contaminated with feces, and then touch their mouths. Health care workers can spread the bacteria to their patients if their hands are contaminated and they do not follow proper hand hygiene. Using antibiotics increases the chance of developing C. difficile. Antibiotics can destroy a person’s good bowel bacteria, which allow C. difficile to grow. When this happens, the C. difficile bacteria produce toxins which can damage the bowel and cause diarrhea. Some people can have C. difficile bacteria present in their bowel and not show any symptoms. Healthy people usually are not at risk of serious illness, but the elderly and those with other illnesses, who are taking antibiotics, are at greater risk of infection.

• #88 Clostridioides difficile infection CDI – including symptoms treatment and prevention | SA Health

  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/clostridium+difficile+infection/clostridioides+difficile+infection+cdi+-+including+symptoms+treatment+and+prevention

  Clostridioides difficile (previously known as Clostridium difficile) infection (CDI) is a disease of the large intestine caused by toxins produced by the spore forming bacterium Clostridioides difficile. […] C. Difficile is transmitted from person to person by the faeco-oral route. The main source of transmission is patients with symptomatic infection. These people shed large numbers of C. difficile spores and bacteria in the faeces, resulting in widespread contamination of their skin, bed linen and nearby environmental surfaces. […] The trigger for symptoms is usually a disturbance of the normal bacteria in the gut during antibiotic treatment. This allows C. difficile to colonise (become established in) and multiply in the gut and produce toxins that attack the lining of the gut wall.

• #89 C. difficile infection – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691

  Clostridioides difficile (klos-TRID-e-oi-deez dif-uh-SEEL) is a bacterium that causes an infection of the colon, the longest part of the large intestine. […] Illness from C. difficile often occurs after using antibiotic medicines. It mostly affects older adults in hospitals or in long-term care settings. People not in care settings or hospitals also can get C. difficile infection. Some strains of the bacterium that can cause serious infections are more likely to affect younger people. […] C. difficile bacteria enter the body through the mouth. They can begin reproducing in the small intestine. When they reach the part of the large intestine, called the colon, the bacteria can release toxins that damage tissues. These toxins destroy cells and cause watery diarrhea. […] Some people carry C. difficile bacteria in their intestines but never get sick from it. These people are carriers of the bacteria. They can spread infections without being sick.

• #90 C. diff Infections | C. difficile | MedlinePlus

  https://medlineplus.gov/cdiffinfections.html

  C. diff is a bacterium that can cause diarrhea and more serious intestinal conditions such as colitis. It causes close to half a million illnesses each year. […] C. diff bacteria are commonly found in the environment, but people usually only get C. diff infections when they are taking antibiotics. That’s because antibiotics not only wipe out bad germs, but they also kill the good germs that protect your body against infections. The effect of antibiotics can last as long as several months. If you come in contact with C. diff germs during this time, you can get sick. You are more likely to get a C. diff infection if you take antibiotics for more than a week. […] C. diff spreads when people touch food, surfaces, or objects that are contaminated with feces (poop) from a person who has C. diff.

• #91 Clostridium difficile

  https://mobile.fpnotebook.com/GI/ID/ClstrdmDfcl.htm

  First recognized in 1978 as a cause of Antibiotic-Associated Diarrhea in 1978 […] Clostridium difficile was reclassified as Clostridioides difficile in 2016. […] Causes Secretory Diarrhea and mucosal injury with colitis. […] Two toxins are typically produced: Enterotoxin A (accompanies Toxin B in some cases) and Cytotoxin B (present in all cases). […] New virulent epidemic strain: NAP1/B1/027. […] Strain responsible for the 5 fold increase in C. difficile infections from 1999 to 2007. […] C. difficile is acquired in health care settings in 94% of cases. […] Colonization occurs in 7 to 26% of acute care facilities. […] Colonization risk increases for each day of hospitalization. […] Colonization is community acquired in 41% of cases. […] Up to 15% of healthy adults are colonized with C difficile.

• #92 C. diff (Clostridium difficile): Symptoms and Treatment

  https://www.healthline.com/health/what-is-c-diff

  C. diff is a type of bacteria that can cause diarrhea, abdominal pain, and tenderness. […] C. diff, short for Clostridium difficile, is a form of infectious bacterium. It can cause a range of symptoms but most commonly results in colitis, which is the inflammation of the wall of your colon. […] According to the American College of Gastroenterology, between 4% and 15% of healthy adults have C. diff in their intestines. Up to 70% of infants have C. diff at birth, reports the Centers for Disease Control and Prevention (CDC). […] Other bacteria that live in the intestines usually keep the amount of C. diff under control. However, in some instances, a C. diff infection can occur. This includes via: […] C. diff is contagious and can pass from person to person. Touching objects, including food and surfaces, that have been in contact with feces (poop) from someone who has C. diff can transmit the bacteria. […] Antibiotics help fight off bad bacteria. However, the drug doesn’t always know the difference between good and bad germs. This means it may sometimes remove good bacteria that protect our body from infections like C. diff.

• #93 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  C. difficile is the most commonly recognized cause of infectious diarrhea in healthcare settings. […] The emergence of the virulent, epidemic ribotype 027 strain was associated with increased incidence, severity, and mortality during the mid-2000s and resulted in outbreaks across North America. […] The recent isolates of the 027 strain are more highly resistant to fluoroquinolones compared to historic strains of the same type. […] The risk of CDI increases with the length of stay, the most appropriate denominator for HO-CDI rates is the number of patient-days. […] The most important modifiable risk factor for the development of CDI is exposure to antibiotic agents. […] The disruption of the intestinal microbiota by antibiotics is long-lasting, and risk of CDI increases both during therapy and in the 3-month period following cessation of therapy. […] Advanced age, potentially as a surrogate for severity of illness and comorbidities, is one of the most important risk factors for CDI. […] The potential role of asymptomatically colonized patients in transmission has recently been highlighted.

• #94 Clostridium difficile infection, Infectious Diseases – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/clostridium-difficile-infection/

  Diarrhea is the key symptom of Clostridium difficile infection, with various degrees of abdominal cramping and pain in most patients, but accompanied by fever in a minority (28%). Occasionally, patients also have nausea and vomiting. […] The source for C. difficile will be the environment of the hospital or nursing home or the hands of healthcare workers. Asymptomatic carriage of C. difficile (so-called endogenous C. difficile) occurs very infrequently, probably no more than 1-2% of community residents in Western cultures. However, patients in hospitals or nursing homes may acquire C. difficile and can carry it for weeks to months without having symptoms as a result of having a good antibody response to the toxins of C. difficile. […] Antimicrobial use, including many chemotherapeutic agents, is by far the greatest risk for CDI. The Centers for Disease Control and Prevention (CDC) estimates that 94% of all CDI is healthcare exposure related, either through inpatient or outpatient care.

• #95 Clostridium difficile (C. diff ) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/c-diff-infection

  Clostridium difficile is a type of bacteria commonly found in the soil, air, and water. It is present in small amounts in the bodies of 1 to 3% of the U.S. population. Under normal circumstances, it doesnt cause any harm. But it is opportunistic, and if given room to grow, it multiplies and crowds out the beneficial bacteria in the gut. This can happen during or after a course of antibiotics, which are meant to kill bacteria that cause infections, but also end up wiping out the helpful bacteria. […] When a C. diff infection takes hold, it releases toxins that inflame the lining of the colon, causing symptoms ranging from slightly loose stools to severe diarrhea, as well as fever and abdominal pain. […] An estimated two-thirds of C. diff infections originate in hospitals, long-term care facilities, or other health care settings. Often, a C. diff infection develops once the patient is home. And cases acquired solely in the community (not in a hospital or similar setting) have also been on the rise.

• #96 Patient education: Antibiotic-associated diarrhea caused by Clostridioides difficile (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/antibiotic-associated-diarrhea-caused-by-clostridioides-difficile-beyond-the-basics/print

  C. difficile infections have become more frequent, more severe, more difficult to treat, and more likely to recur after initial treatment. Although most people become infected with C. difficile in the hospital, community-acquired infection in patients who have not been hospitalized has also become more common. Community-acquired C. difficile infection can develop in the absence of any recent antibiotic use. […] A number of factors can increase a person’s risk of becoming infected with C. difficile: Current or recent antibiotic use – Certain antibiotics increase the risk of becoming infected with C. difficile more than others. Current or recent hospitalization – Up to 20 percent of people who are hospitalized and up to 50 percent of people in long-term care facilities (eg, nursing homes) carry C. difficile in their feces, but many do not have diarrhea or other symptoms. Exposure to these carriers significantly increases a person’s risk of becoming infected. Older age – The risk of becoming infected with C. difficile is 10 times greater in people who are 65 years or older. Severe illness – People who have a weakened immune system as a result of an underlying medical condition or a treatment (eg, chemotherapy) are at increased risk of becoming infected with C. difficile, especially during a hospital stay. Recent infection with C. difficile – People who have been recently infected with C. difficile and treated have an increased risk of becoming infected again soon after stopping the treatment. Inflammatory bowel disease (ulcerative colitis or Crohn’s disease with colitis) – People with colitis from inflammatory bowel disease have an increased risk of developing C. difficile infection. In this circumstance, C. difficile infection may develop in the absence of prior antibiotic treatment.

• #97 What Is C. Diff? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/c-diff/guide/

  Yet in people with weakened immune systems or recent antibiotic use, for example, C. diff can lead to illness from the release of toxins that attack the lining of the organ. […] Although people with no known risk factors can get a C. diff infection, certain things increase your risk, including the heavy use of antibiotics for the treatment of long-term infections. These antibiotics can disrupt the normal makeup of the gut microbiome the community of microbes living in the intestines allowing C. diff to grow out of control and cause an infection. […] Risk factors also include older age, having a severe underlying disease such as inflammatory bowel disease (IBD) or colorectal cancer, or having a weakened immune system. […] In addition, the use of proton pump inhibitors (PPIs), a type of medicine that reduces stomach acid and treats acid reflux, also may increase your risk of C. diff infection. […] Most C. diff infections occur in people who are or who have recently been in healthcare facilities such as hospitals, nursing homes, and rehabilitation centers. In these facilities, germs spread easily, antibiotic use is common, and patients are particularly vulnerable to infection.

• #98 C. Difficile Causes, Symptoms, and Treatments | UPMC

  https://www.upmc.com/services/division-infectious-diseases/conditions/clostridioides-difficile

  C. difficile, or C. diff, is a bacteria that causes problems in the digestive system. This germ causes inflammation in the colon (colitis), leading to diarrhea and other symptoms. […] C. diff infections are most common in people who took antibiotics for another infection. […] C. diff bacteria gets into the digestive tract through contact with food or surfaces contaminated with C. diff spores. […] But antibiotics may harm the good protective microbes that allow the body to fight off C. diff. This can lead to the bacteria becoming active in the gut, which then causes symptoms. […] C. diff spores are all around us, but they’re more common in hospitals and nursing homes. […] Older people and people with existing health problems are more likely to get a C. diff infection. […] C. diff is also contagious. You can get it if you’re around someone who has it.

• #99 What Is C. Diff? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/c-diff/guide/

  Clostridioides difficile commonly known as C. difficile or C. diff is a bacterium that causes diarrhea and colitis (inflammation of the colon). Its typically found in feces and can easily contaminate food and surfaces. […] Many people develop it while theyre hospitalized for surgery or receiving care for other illnesses. C. diff infection most commonly affects older adults in hospitals or in long-term care facilities and usually results from the use of antibiotics. But research suggests rates of C. diff infection are increasing, and cases are being diagnosed in young, healthy individuals who havent used antibiotics and who havent been in a healthcare facility. […] C. diff bacteria is found in feces. Its also in soil, air, and water. […] C. diff or its spores will get into your body if you ingest contaminated food or water or touch unwashed fingers to your mouth after handling contaminated surfaces or objects.

• #100 About C. diff | C. diff | CDC

  https://www.cdc.gov/c-diff/about/index.html

  C. diff is a germ that causes diarrhea and colitis (an inflammation of the colon) and can be life-threatening. […] C. diff can affect anyone. Most cases of C. diff infection occur when you’ve been taking antibiotics or not long after you’ve finished the antibiotic course. […] C. diff germs spread from person to person in poop, but the bacteria are often found in the environment. Finding C. diff germs in the home is not unusual, even when no one in the home has been ill with C. diff infection. […] When C. diff germs are outside the body, they become spores. These spores are an inactive form of the germ and have a protective coating allowing them to live for months or years on surfaces and in the soil. The germs become active again when you swallow these spores and they reach the intestines.

• #101 Pseudomembranous colitis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pseudomembranous-colitis/symptoms-causes/syc-20351434

  C. difficile spores are resistant to many common disinfectants and can be transmitted from the hands of health care professionals to patients. […] More and more often, C. difficile is being reported in people with no known risk factors, including people with no recent health care contact or use of antibiotics. This is called community-acquired C. difficile. […] An aggressive strain of C. difficile has emerged that produces far more toxins than other strains do. The new strain may be more resistant to certain medicines and has been reported in people who haven’t been in the hospital or taken antibiotics.

• #102 Clostridium difficile (C. diff ) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/c-diff-infection

  People are seven to 10 times more likely to get C. diff while taking antibiotics and for up to one month after, according to the CDC. For some people, an infection may occur several months after completing a course of antibiotics. […] Also, C. diff bacteria can survive for months and arent easily eradicated by all disinfectants (including alcohol-based hand sanitizers). Only cleaners such as bleach can kill the spores. […] C. diff is treated with the very thing that most often causes itantibiotics. However, if you contract C. diff while on antibiotics, your doctor will likely have you stop the medication you are taking and try a different type. […] Unfortunately, C. diff reinfection is fairly common, occurring in about 20 percent of patients. For those patients, a stronger type of antibiotic may be necessary, or a fecal transplant (using stool transferred from a healthy patient). This method, says Matthew Grant, MD, a Yale Medicine infectious diseases specialist, is often more effective than antibiotics.

• #103 C. Difficile Causes, Symptoms, and Treatments | UPMC

  https://www.upmc.com/services/division-infectious-diseases/conditions/clostridioides-difficile

  Risk factors of C. diff include: Being age 65 or older. Having a weakened immune system. Solid organ or bone marrow transplants, HIV/AIDS, or certain medicines can weaken your immune system. Having had a past infection of C. diff. Having certain chronic health issues, such as cancer, kidney disease, or inflammatory bowel disease. Staying in a hospital or nursing home. Having had a recent surgery in the digestive system. Taking medicines called proton pump inhibitors to treat problems from stomach acid. […] Without treatment, C. diff can cause severe problems or even death. […] C. diff can also recur despite a good first response to the anti-C. diff therapy. […] C. diff returns in about one in six people, usually within the two to eight weeks after stopping anti-C. diff therapy. But it can take as long as three months to come back.

• #104 Biliary Tract Disorders, Gallbladder Disorders, & Gallstone Pancreatitis | ACG

  https://gi.org/topics/c-difficile-infection/

  While antibiotics are effective in treating most cases of CDI, the symptoms recur after the end of treatment in 10-20% of cases. This is called recurrent CDI and usually occurs 1–2 weeks after stopping treatment. After a recurrence, the chance of further recurrences goes up to 40-60%, perhaps because one is using an antibiotic to treat a disease caused by antibiotics. We presume that the normal colonic bacteria have not had a chance to recolonize. Current recommendations for the treatment of recurrent CDI include a vancomycin taper over six to eight weeks or fidaxomicin for ten days. Bezlotuxumab is a recently approved drug to prevent recurrent infections and is given as a one-time IV infusion during a course of antibiotics for CDI. The most effective treatment, however, is fecal microbiota transplant (FMT). FMT is typically administered via colonoscopy where stool from a healthy donor is instilled into the colon of a patient with recurrent CDI. In studies, it has been effective in over 90% of patients who received the treatment, and has been proven effective with several randomized controlled trials. There are ongoing clinical trials using oral encapsulated forms of FMT, which are the future of this “drug.”

• #105 Clostridium difficile (C. diff ) > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/c-diff-infection

  People are seven to 10 times more likely to get C. diff while taking antibiotics and for up to one month after, according to the CDC. For some people, an infection may occur several months after completing a course of antibiotics. […] Also, C. diff bacteria can survive for months and arent easily eradicated by all disinfectants (including alcohol-based hand sanitizers). Only cleaners such as bleach can kill the spores. […] C. diff is treated with the very thing that most often causes itantibiotics. However, if you contract C. diff while on antibiotics, your doctor will likely have you stop the medication you are taking and try a different type. […] Unfortunately, C. diff reinfection is fairly common, occurring in about 20 percent of patients. For those patients, a stronger type of antibiotic may be necessary, or a fecal transplant (using stool transferred from a healthy patient). This method, says Matthew Grant, MD, a Yale Medicine infectious diseases specialist, is often more effective than antibiotics.

• #106 What is C. Diff? Symptoms, Treatment, & Support | Ferring Microbiome

  https://microbiome.ferring.com/patient-c-diff-infection/

  FMT may be a good option to consider for people who have had C. diff multiple times, after antibiotic treatment. […] Probiotics are not recommended for use to prevent or treat a C. diff infection. […] Just when it seems C. diff is done and gone, it comes roaring back. Even after treatment, some people experience repeat infections this is called recurrent C. diff. […] Around half a million infections are caused by C. diff every year. […] Up to 3 in 10 people who get a C. diff infection will get it again. […] After 1st recurrence, up to 6 in 10 people will get another C. diff infection.

• #107 What Is C. diff? Symptoms, Causes, and Treatments Explained – BuzzRx

  https://www.buzzrx.com/blog/what-is-c-diff

  Other known risk factors for C. difficile infections are healthcare settings, such as hospitals, long-term care facilities, and nursing homes. These are places where antibiotic use is common, and germs can spread easily. […] However, C. difficile infections can also occur without antibiotic use and outside hospitals and care settings. Some strains of the bacteria that can cause serious infections are more likely to infect younger people. […] The risk increases with each subsequent infection. People who have had three or more C. difficile infections have a more than 50% risk of having another one. […] C. diff germs are mainly transmitted from feces (stool) to the mouth. After the bacteria enter the body through the mouth, they start multiplying in the small intestine. When they reach the colon (large intestine), they release toxins and cause damage, resulting in severe diarrhea.

• #108 Clostridium difficile Infection: What You Need to Know | Consultant360

  https://www.consultant360.com/article/clostridium-difficile-infection-what-you-need-know

  Recurrent C difficile associated diarrhea occurs in approximately 20% of patients, although why the disease recurs in certain individuals is not entirely clear. […] One explanation is that C difficile spores are resistant to antibiotics so that several days after antibiotic therapy is discontinued, the surviving spores transform into active bacterial forms which will multiply and produce toxins again. […] Another explanation for the recurrence of C difficile infection is the host’s inadequate production of antibodies against the bacterial toxins. […] The host’s susceptibility and the virulence factors of the bacterial strain ultimately determine the outcome of the infection.

• #109 Clostridium difficile Infection: What You Need to Know | Consultant360

  https://www.consultant360.com/article/clostridium-difficile-infection-what-you-need-know

  Recurrent C difficile associated diarrhea occurs in approximately 20% of patients, although why the disease recurs in certain individuals is not entirely clear. […] One explanation is that C difficile spores are resistant to antibiotics so that several days after antibiotic therapy is discontinued, the surviving spores transform into active bacterial forms which will multiply and produce toxins again. […] Another explanation for the recurrence of C difficile infection is the host’s inadequate production of antibodies against the bacterial toxins. […] The host’s susceptibility and the virulence factors of the bacterial strain ultimately determine the outcome of the infection.

• #110 Biliary Tract Disorders, Gallbladder Disorders, & Gallstone Pancreatitis | ACG

  https://gi.org/topics/c-difficile-infection/

  While antibiotics are effective in treating most cases of CDI, the symptoms recur after the end of treatment in 10-20% of cases. This is called recurrent CDI and usually occurs 1–2 weeks after stopping treatment. After a recurrence, the chance of further recurrences goes up to 40-60%, perhaps because one is using an antibiotic to treat a disease caused by antibiotics. We presume that the normal colonic bacteria have not had a chance to recolonize. Current recommendations for the treatment of recurrent CDI include a vancomycin taper over six to eight weeks or fidaxomicin for ten days. Bezlotuxumab is a recently approved drug to prevent recurrent infections and is given as a one-time IV infusion during a course of antibiotics for CDI. The most effective treatment, however, is fecal microbiota transplant (FMT). FMT is typically administered via colonoscopy where stool from a healthy donor is instilled into the colon of a patient with recurrent CDI. In studies, it has been effective in over 90% of patients who received the treatment, and has been proven effective with several randomized controlled trials. There are ongoing clinical trials using oral encapsulated forms of FMT, which are the future of this “drug.”

• #111 How to Prevent C. Diff Infection from Recurring

  https://www.healthline.com/health/preventing-c-diff-infection-from-recurring

  Clostridioides difficile (C. diff) is a type of bacteria that may lead to severe diarrhea and colon inflammation. Its often associated with taking antibiotics. […] C. diff infections most commonly occur when youre taking antibiotics. These medications kill both the bad and good germs in your body, which includes those responsible for fighting off infections. […] The reason for C. diff recurrence isnt fully understood. Researchers believe several factors may increase your risk of infections, such as having: remaining spores persisting after the initial infection (relapse), a weakened immune system, altered gut microbiome from taking antibiotics. […] The most significant modifiable risk factor for C. diff recurrence is antibiotic use. This means its a risk factor that can be changed. […] Studies have found that previous use of antibiotics increases the risk of recurrent C. diff infection.

• #112 Recurrent C. Diff Infections – Symptoms, Causes, Prevention, Treatment

  https://guides.clarahealth.com/recurrent-c-diff-infections/

  The exact reason for more cases of C. diff in individuals over the age of 65 is unknown, but it is possible a weakened immune system may inhibit the bodys ability to fight a C. diff infection. […] Antibiotics can disturb the healthy balance in the gut, especially acid composition in the colon which promotes C. diff growth. […] For those who have had C. diff in the past, antibiotics, like vancomycin, are prescribed to target toxin-producing C. diff bacteria. However, there may be other dormant forms of the bacteria that remain in the gut. Once a course of antibiotics is complete, the dormant C. diff spores may become active, causing recurrence. […] Lowered acidity in the gut may increase the risk of a C. diff infection. […] Most antibiotics carry a risk for C. diff infections, however, some antibiotics carry a higher risk due to their spectrum of coverage.

• #113 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  Advanced age (65 y) and hospitalization (particularly sharing a hospital room with an infected patient, intensive care unit stays, and prolonged hospital stays) are known risk factors for infection with C difficile, as are comorbidities such as kidney disease, liver disease, and cardiovascular disease. […] Risk factors for recurrence of CDI include age older than 65 years, immune compromise, severe underlying illnesses, ongoing antibiotic treatments during CDI, and severe CDI on presentation. […] Ultimately, many of the genetic influences on CDI and the clinical course of C difficile colitis likely remain unknown.

• #114 How to Prevent C. Diff Infection from Recurring

  https://www.healthline.com/health/preventing-c-diff-infection-from-recurring

  Since 2003, C. diff cases have become more frequent, harmful, recurring, and less responsive to treatment. This may be due to the emergence of a severe strain of C. diff known as NAP1/BI/027. […] This specific strain of C. diff produces more toxins than other strains. […] Risk factors such as older age, antibiotic use, gastric acid suppression, and a weakened immune system may increase the likelihood of C. diff recurrence.

• #115 Clostridioides (Clostridium) Difficile Colitis: Background, Etiology, Pathophysiology

  https://emedicine.medscape.com/article/186458-overview

  Advanced age (65 y) and hospitalization (particularly sharing a hospital room with an infected patient, intensive care unit stays, and prolonged hospital stays) are known risk factors for infection with C difficile, as are comorbidities such as kidney disease, liver disease, and cardiovascular disease. […] Risk factors for recurrence of CDI include age older than 65 years, immune compromise, severe underlying illnesses, ongoing antibiotic treatments during CDI, and severe CDI on presentation. […] Ultimately, many of the genetic influences on CDI and the clinical course of C difficile colitis likely remain unknown.

• #116 How to Prevent C. Diff Infection from Recurring

  https://www.healthline.com/health/preventing-c-diff-infection-from-recurring

  Clostridioides difficile (C. diff) is a type of bacteria that may lead to severe diarrhea and colon inflammation. Its often associated with taking antibiotics. […] C. diff infections most commonly occur when youre taking antibiotics. These medications kill both the bad and good germs in your body, which includes those responsible for fighting off infections. […] The reason for C. diff recurrence isnt fully understood. Researchers believe several factors may increase your risk of infections, such as having: remaining spores persisting after the initial infection (relapse), a weakened immune system, altered gut microbiome from taking antibiotics. […] The most significant modifiable risk factor for C. diff recurrence is antibiotic use. This means its a risk factor that can be changed. […] Studies have found that previous use of antibiotics increases the risk of recurrent C. diff infection.

• #117

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=uf6176spec

  Clostridioides difficile (also called C. diff) are bacteria that can cause swelling and irritation of the large intestine, or colon. This inflammation, known as colitis, can cause diarrhea, fever, and abdominal cramps. […] You may get C. diff colitis if you take antibiotics. C. diff also can be passed from person to person. But the infection is most common in people who are taking antibiotics or have taken them recently. It is also common in older people who are in hospitals and nursing homes and in people who are getting chemotherapy for cancer. […] The large intestine has many good bacteria that keep it healthy and do not cause disease. If you take antibiotics to kill bacteria that do cause disease, your medicine may also kill the good bacteria. This may allow Clostridioides difficile (C. diff) bacteria to grow in your large intestine. They can release harmful substances called toxins. […] When the toxins are released, the colon becomes inflamed. […] People who take medicines that reduce stomach acid, such as Nexium, Prevacid, or Losec, also have a greater risk of getting a C. diff infection.

• #118 Recurrent C. Diff Infections – Symptoms, Causes, Prevention, Treatment

  https://guides.clarahealth.com/recurrent-c-diff-infections/

  The exact reason for more cases of C. diff in individuals over the age of 65 is unknown, but it is possible a weakened immune system may inhibit the bodys ability to fight a C. diff infection. […] Antibiotics can disturb the healthy balance in the gut, especially acid composition in the colon which promotes C. diff growth. […] For those who have had C. diff in the past, antibiotics, like vancomycin, are prescribed to target toxin-producing C. diff bacteria. However, there may be other dormant forms of the bacteria that remain in the gut. Once a course of antibiotics is complete, the dormant C. diff spores may become active, causing recurrence. […] Lowered acidity in the gut may increase the risk of a C. diff infection. […] Most antibiotics carry a risk for C. diff infections, however, some antibiotics carry a higher risk due to their spectrum of coverage.

• #119 Recurrent C. Diff Infections – Symptoms, Causes, Prevention, Treatment

  https://guides.clarahealth.com/recurrent-c-diff-infections/

  The rate of repeat infection varies from 5% to 50% among patients with a resolved first infectionthe recurrence rate varies according to risk factors like age, exposure to hospital environments, and an underlying disease like kidney failure. However, the typical recurrence rate among patients is approximately 20%. […] Among patients who have already experienced a C. diff infection twice, the rate of reinfection is approximately 45% to 65%. […] Be aware that antibiotics can negatively impact the gutbroad spectrum antibiotics can kill healthy bacteria increasing susceptibility to a repeat C. diff infection. […] For example, over 60% of cases of healthcare related C. diff infection cases may have began in long term care facilities.

• #120 How to Prevent C. Diff Infection from Recurring

  https://www.healthline.com/health/preventing-c-diff-infection-from-recurring

  Since 2003, C. diff cases have become more frequent, harmful, recurring, and less responsive to treatment. This may be due to the emergence of a severe strain of C. diff known as NAP1/BI/027. […] This specific strain of C. diff produces more toxins than other strains. […] Risk factors such as older age, antibiotic use, gastric acid suppression, and a weakened immune system may increase the likelihood of C. diff recurrence.

• #121 C. Diff Infection: Symptoms, Causes, Diagnosis and Treatment

  https://www.webmd.com/digestive-disorders/clostridium-difficile-colitis

  Clostridioides Difficile Causes […] C. diff exists all around us. It’s in the air, water, soil, and the feces of humans and animals. […] Clostridium difficile (C. diff) is a highly contagious bacterial infection of the colon. It’s typically caused by taking certain antibiotics, which can interfere with the balance between good and bad bacteria in your gut. […] C. diff bacteria that are outside the body turn into spores that can live on surfaces for weeks or months. These spores are not „active,” but they can turn active after you swallow them and they get into your intestines. Some people have the bacteria in their intestines and never have any symptoms. But for others, the bacteria make toxins that attack the intestines. […] A new strain of C. diff bacteria makes larger amounts of toxins. These types are hard to treat with medications.

• #122 Biliary Tract Disorders, Gallbladder Disorders, & Gallstone Pancreatitis | ACG

  https://gi.org/topics/c-difficile-infection/

  While antibiotics are effective in treating most cases of CDI, the symptoms recur after the end of treatment in 10-20% of cases. This is called recurrent CDI and usually occurs 1–2 weeks after stopping treatment. After a recurrence, the chance of further recurrences goes up to 40-60%, perhaps because one is using an antibiotic to treat a disease caused by antibiotics. We presume that the normal colonic bacteria have not had a chance to recolonize. Current recommendations for the treatment of recurrent CDI include a vancomycin taper over six to eight weeks or fidaxomicin for ten days. Bezlotuxumab is a recently approved drug to prevent recurrent infections and is given as a one-time IV infusion during a course of antibiotics for CDI. The most effective treatment, however, is fecal microbiota transplant (FMT). FMT is typically administered via colonoscopy where stool from a healthy donor is instilled into the colon of a patient with recurrent CDI. In studies, it has been effective in over 90% of patients who received the treatment, and has been proven effective with several randomized controlled trials. There are ongoing clinical trials using oral encapsulated forms of FMT, which are the future of this “drug.”

• #123 Biliary Tract Disorders, Gallbladder Disorders, & Gallstone Pancreatitis | ACG

  https://gi.org/topics/c-difficile-infection/

  While antibiotics are effective in treating most cases of CDI, the symptoms recur after the end of treatment in 10-20% of cases. This is called recurrent CDI and usually occurs 1–2 weeks after stopping treatment. After a recurrence, the chance of further recurrences goes up to 40-60%, perhaps because one is using an antibiotic to treat a disease caused by antibiotics. We presume that the normal colonic bacteria have not had a chance to recolonize. Current recommendations for the treatment of recurrent CDI include a vancomycin taper over six to eight weeks or fidaxomicin for ten days. Bezlotuxumab is a recently approved drug to prevent recurrent infections and is given as a one-time IV infusion during a course of antibiotics for CDI. The most effective treatment, however, is fecal microbiota transplant (FMT). FMT is typically administered via colonoscopy where stool from a healthy donor is instilled into the colon of a patient with recurrent CDI. In studies, it has been effective in over 90% of patients who received the treatment, and has been proven effective with several randomized controlled trials. There are ongoing clinical trials using oral encapsulated forms of FMT, which are the future of this “drug.”

• #124 Biliary Tract Disorders, Gallbladder Disorders, & Gallstone Pancreatitis | ACG

  https://gi.org/topics/c-difficile-infection/

  While antibiotics are effective in treating most cases of CDI, the symptoms recur after the end of treatment in 10-20% of cases. This is called recurrent CDI and usually occurs 1–2 weeks after stopping treatment. After a recurrence, the chance of further recurrences goes up to 40-60%, perhaps because one is using an antibiotic to treat a disease caused by antibiotics. We presume that the normal colonic bacteria have not had a chance to recolonize. Current recommendations for the treatment of recurrent CDI include a vancomycin taper over six to eight weeks or fidaxomicin for ten days. Bezlotuxumab is a recently approved drug to prevent recurrent infections and is given as a one-time IV infusion during a course of antibiotics for CDI. The most effective treatment, however, is fecal microbiota transplant (FMT). FMT is typically administered via colonoscopy where stool from a healthy donor is instilled into the colon of a patient with recurrent CDI. In studies, it has been effective in over 90% of patients who received the treatment, and has been proven effective with several randomized controlled trials. There are ongoing clinical trials using oral encapsulated forms of FMT, which are the future of this “drug.”

• #125 The cost of Clostridium difficile infections • healthcare-in-europe.com

  https://healthcare-in-europe.com/en/news/the-cost-of-clostridium-difficile-infections.html

  Treatments for recurrences of C. difficile infection include stopping the antibiotic that made the patient susceptible to the infection and starting a different antibiotic that is effective against C. difficile infection. […] Faecal transplantation is emerging as a promising option; this is a process in which the good bacteria that the gut needs but which has been killed off by antibiotics is transplanted into the patient from a healthy donor.

• #126 Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection

  https://www.mdpi.com/2076-2607/12/5/1004

  While antibiotics are common treatments, high recurrence rates necessitate alternative therapies. Bezlotoxumab, targeting TcdB, is the only available anti-toxin, yet limitations persist, prompting ongoing research. This review highlights the current knowledge of the structure and mechanism of action of C. difficile toxins and their role in disease. By comprehensively describing the toxin-mediated mechanisms, this review provides insights for the future development of novel treatment strategies and the management of CDI. […] C. difficile is classified by the Centers for Disease Control and Prevention (CDC) as one of the top five urgent threats to human health. Historically healthcare-associated, CDI shows an alarming rise in community-acquired cases with approximately 780,000 infections and 49,000 deaths annually in Europe and the United States. These data emphasize the significance of CDI as a public health problem, compounded by its economic burden, exceeding USD 3 billion in Europe and USD 800 million in the United States annually.

• #127 Long-lasting C. diff infections: A threat to the gut – Harvard Health

  https://www.health.harvard.edu/blog/long-lasting-c-diff-infections-a-threat-to-the-gut-202311012987

  This is the reality for nearly 500,000 Americans each year who have the bacterial infection known as Clostridioides difficile, or C. diff. […] The spores only sicken people whose gut microbiome the trillions of organisms living in their intestines becomes imbalanced for one of the various reasons described below. When an imbalance occurs, the spores start to multiply and create toxins that lead to a C. diff infection. […] „It’s the toxin that makes you sick.” […] C. diff is the top cause of health care-associated infections in the US. […] People are up to 10 times more likely to get C. diff while on antibiotics or during the month afterward, according to the CDC. […] The type of antibiotic prescribed also matters, according to a 2023 study in the journal Open Forum Infectious Diseases. Researchers compared more than 159,000 people who had C. diff infection with 797,000 healthy controls. Study findings suggest that using clindamycin and later-generation cephalosporin antibiotics pose the greatest risk for C. diff infection. […] Ironically, C. diff therapy typically starts with antibiotics, despite the infection’s proliferation due to antibiotic use.

• #128 Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection

  https://www.mdpi.com/2076-2607/12/5/1004

  CDT induces an increased local and systemic inflammatory response in the host and enhances the disruption of the host defense mechanisms caused by TcdA and TcdB. CDT triggers an inflammatory response in the host by suppressing the protective eosinophils of the colon and blood through the indirect induction of eosinophil apoptosis. […] CDI is typically treated with antibiotics, with vancomycin, metronidazole, and fidaxomicin being the recommended choices for both primary and recurrent cases. However, the prolonged use of antibiotics may cause antibiotic resistance and microbiota disruption, which predispose to recurrence. These limitations highlight the need for novel and effective management strategies. […] Contemporary therapeutic approaches to CDI primarily focus on targeting the toxins produced by C. difficile. Research interest has therefore centered on developing new therapies that aim to neutralize these toxins, addressing the effects of toxins that are not tackled by current antibiotic-based treatment regimens. Toxin-based therapies not only help in treating the infection but also promote the preservation of the host’s microbiota. Additionally, vaccination against toxins offers protection against CDI by activating the immune system to defend against the development of the infection.

• #129 C. diff: An Urgent Public Health Threat

  https://www.nfid.org/c-diff-an-urgent-public-health-threat/

  In addition to existing treatment options, these new drugs present promising developments in alleviating the burden of recurrent infections, a major concern for patients and healthcare professionals. […] Only take or prescribe antibiotics when absolutely necessary. In addition to contributing to the rising threat of antibiotic resistance, overuse of antibiotics puts individuals 7-10 times more at risk for contracting C. diff.

• #130 Clostridium difficile

  https://mobile.fpnotebook.com/GI/ID/ClstrdmDfcl.htm

  Asymptomatic patients account for 50% C. difficile colonization cases. […] Most strains in infants are non-toxic, and likely due to peripartum hospitalization. […] Risk of C. difficile infection increases 2% for each year over age 18 years old. […] All Antibiotics can cause C. difficile Diarrhea (even single dose perioperative Antibiotics). […] Broad-spectrum agents are highest risk. […] Up to 40% of C. difficile are in patients without recent Antibiotic use. […] Clindamycin is a common cause since resurgence for MRSA management. […] Fluoroquinolones are emerging as a very common cause. […] Antibiotic Stewardship decreases c. difficile infection rates by 50%.

• #131 C. Diff Infection: Symptoms, Causes, Diagnosis and Treatment

  https://www.webmd.com/digestive-disorders/clostridium-difficile-colitis

  Ask your health care professionals to wash their hands thoroughly before and after caring for you. […] Request that all medical equipment be sanitized before being brought into your room. […] Wash your hands with soap and water after using the bathroom and before eating. […] Another way to help prevent C. diff is to avoid unnecessary antibiotics. Talk this over with your doctor and see if there are other treatment options. And don’t take antibiotics without a doctor’s OK. […] Many C. diff infections are mild and short-lived, but others can be quite serious. Take precautions, and don’t hesitate to seek medical help if you have symptoms. […] […] […] Clostridioides Difficile FAQs […] Clostridioides difficile is a very contagious bacterial infection that causes symptoms such as frequent watery diarrhea, abdominal cramping, nausea, fever, blood in your stool, and a rapid heartbeat. C. diff usually occurs after a course of certain antibiotics, known as broad-spectrum antibiotics, which kill good and bad bacteria in your gut and allow C. diff to take over. Risk factors for C. diff include being over age 65; a stay in a hospital, nursing home, or long-term care facility where treatment with antibiotics is common; and a history of previous C. diff infection. Severe C. diff can cause serious complications. If you’ve recently taken a course of antibiotics, see your doctor if you have watery diarrhea for more than a couple of days, develop a fever, or have severe cramping and abdominal pain.

• #132

• #133 Common Questions About Clostridium difficile Infection | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0315/p437.html

  Clostridium difficile infection is a common cause of antibiotic-associated diarrhea. It causes no symptoms in more than one-half of infected patients, but can also cause a wide spectrum of illnesses and death. The most important modifiable risk factor for C. difficile infection is antibiotic exposure; this risk is dose-related and higher with longer courses and combination therapy. C. difficile infection is also associated with older age, recent hospitalization, multiple comorbidities, use of gastric acid blockers, inflammatory bowel disease, and immunosuppression. The incidence and severity of C. difficile infection have increased. The increased incidence and severity are partially due to an epidemic strain, BI/NAP1/027, which produces higher toxin levels and is highly resistant to fluoroquinolones. Risk factors for the development of C. difficile infection include age older than 64 years, recent hospitalization, antibiotic use, multiple comorbidities, use of gastric acid blockers, previous gastrointestinal surgery, inflammatory bowel disease, and immunosuppression. Antibiotic exposure is the most important modifiable risk factor. Although even single doses of prophylactic antibiotics can cause C. difficile infection, greater number of antimicrobials used, greater number of doses, and longer duration of antibiotic administration increase the risk.

• #134 Recurrent C. Diff Infections – Symptoms, Causes, Prevention, Treatment

  https://guides.clarahealth.com/recurrent-c-diff-infections/

  The rate of repeat infection varies from 5% to 50% among patients with a resolved first infectionthe recurrence rate varies according to risk factors like age, exposure to hospital environments, and an underlying disease like kidney failure. However, the typical recurrence rate among patients is approximately 20%. […] Among patients who have already experienced a C. diff infection twice, the rate of reinfection is approximately 45% to 65%. […] Be aware that antibiotics can negatively impact the gutbroad spectrum antibiotics can kill healthy bacteria increasing susceptibility to a repeat C. diff infection. […] For example, over 60% of cases of healthcare related C. diff infection cases may have began in long term care facilities.

• #135 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Recurrent C. difficile infection is defined by resolution of symptoms during therapy, then reappearance of symptoms two to eight weeks after treatment has ended. The recurrence rate for health care facility-acquired infections is 5% to 50% (median: 20%). […] C. difficile infection is characterized by a wide range of symptoms, from mild or moderate diarrhea to severe disease with pseudomembranous colitis, colonic ileus, toxic megacolon, sepsis, or death. […] The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America recommend limiting testing for C. difficile infection to patients with unexplained onset of three or more unformed stools in 24 hours while not taking laxatives. […] Infection control and good antibiotic stewardship are the cornerstones for reducing the incidence of C. difficile infection in health care and community settings.

• #136 Clostridium difficile

  https://mobile.fpnotebook.com/GI/ID/ClstrdmDfcl.htm

  Asymptomatic patients account for 50% C. difficile colonization cases. […] Most strains in infants are non-toxic, and likely due to peripartum hospitalization. […] Risk of C. difficile infection increases 2% for each year over age 18 years old. […] All Antibiotics can cause C. difficile Diarrhea (even single dose perioperative Antibiotics). […] Broad-spectrum agents are highest risk. […] Up to 40% of C. difficile are in patients without recent Antibiotic use. […] Clindamycin is a common cause since resurgence for MRSA management. […] Fluoroquinolones are emerging as a very common cause. […] Antibiotic Stewardship decreases c. difficile infection rates by 50%.

• #137 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Recurrent C. difficile infection is defined by resolution of symptoms during therapy, then reappearance of symptoms two to eight weeks after treatment has ended. The recurrence rate for health care facility-acquired infections is 5% to 50% (median: 20%). […] C. difficile infection is characterized by a wide range of symptoms, from mild or moderate diarrhea to severe disease with pseudomembranous colitis, colonic ileus, toxic megacolon, sepsis, or death. […] The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America recommend limiting testing for C. difficile infection to patients with unexplained onset of three or more unformed stools in 24 hours while not taking laxatives. […] Infection control and good antibiotic stewardship are the cornerstones for reducing the incidence of C. difficile infection in health care and community settings.

• #138 Clostridioides difficile infections (C. diff, CDI) | Disease Outbreak Control Division

  https://health.hawaii.gov/docd/disease_listing/clostridium-difficile-infections-c-diff-cdi/

  Healthy people usually do not get CDI, however the following will increase the risk of developing CDI: taking antibiotics, proton pump inhibitors (medications to help acid reflux or gastroesophageal reflux disease), recent stay at a hospital or nursing home, a serious underlying illness or weakened immune system (such as with HIV/AIDS, cancer, or organ transplant patients taking immunosuppressive medications), advanced age (65 or older), previous infection with C.diff or known exposure to the germs. […] Poor prescribing practices put patients at risk for CDI. More than half of all hospitalized patients will get an antibiotic at some point during their hospital stay, but studies have shown that 30-50% of antibiotics prescribed in hospitals are unnecessary or incorrect. Additionally, rapidly identifying patients with CDI and using appropriate infection control recommendations can of preventing CDI transmission.

• #139 Why Is C. Diff So Dangerous? C. Diff Awareness Month | Sepsis Alliance

  https://www.sepsis.org/news/why-is-c-diff-so-dangerous-c-diff-awareness-month/

  C. diff is an infection caused by Clostridioides difficile, a bacterium that causes diarrhea and inflammation of the colon, called colitis. […] The biggest risk factor for contracting Clostridioides difficile is taking antibiotics. […] The antibiotics most likely to trigger a Clostridioides difficile infection include ampicillin, amoxicillin, cephalosporin, and clindamycin, along with other broad spectrum antibiotics. […] C. diff is also a big deal because of how easily it can be spread within a healthcare facility. […] Not everyone who has this infection needs treatment. […] It may seem odd to treat a condition caused by antibiotics with more antibiotics, but since Clostridioides difficile is a bacterium, antibiotics are the only way to treat the infection. […] The bacteria are spread through spores that the bacteria release. […] Its important to keep in mind too that hand sanitizers are not effective against C. diff. […] We cant prevent all infections, but we can reduce the chance of contracting C. diff by only taking prescribed antibiotics and not someone elses, even if you believe you have the same type of infection.

• #140 C. Difficile (C. diff) | Sepsis Alliance

  https://www.sepsis.org/sepsisand/c-difficile/

  The only way to prevent developing an infection with C. difficile is by avoiding exposure to the bacteria. The most effective method to do this is by frequent and proper hand washing with soap and water by everyone: patients, visitors, and anyone who works in the healthcare facilities. […] Doctors use specific antibiotics to treat C. difficile, but recommendations vary according to the severity of the infection, how often a patient has had the infection, and the availability of the recommended antibiotics.

• #141 How is C. Diff Spread? Understanding Transmission and Preventing Contagion of C. Difficile Infections

  https://www.qualityinsights.org/quality-quest/how-is-c.-diff-spread-understanding-transmission-and-preventing-contagion-of-c.-difficile-infections

  Clostridioides difficile, or C. diff, is a very contagious bacteria that can cause serious infections, especially in healthcare settings. […] C. diff normally lives in the stomach and intestines, but under certain conditions it can grow and produce toxins that cause symptoms like severe diarrhea and stomach pain. […] Several factors increase the risk of C. diff infections, including: […] Taking antibiotics disrupts the natural balance of good and bad bacteria in the gut. People are 7 to 10 times more likely to get C. diff while on antibiotics and during the month after (Source: CDC). […] C. diff mainly spreads through contact with stool. The bacteria can get on surfaces, and if someone touches these contaminated items and then touches their mouth, they can swallow the bacteria and get infected. […] Yes, C. diff is very contagious. Coming into contact with surfaces or materials that have C. diff spores can spread the infection. […] Effective infection control and hygiene practices are critical in preventing the spread of C. diff, both in healthcare facilities and at home.

• #142 C. diff: Facts for Clinicians | C. diff | CDC

  https://www.cdc.gov/c-diff/hcp/clinical-overview/index.html

  If CDI is confirmed: Use antibiotics appropriately. […] In about 20% of patients, CDI will resolve within two to three days of discontinuing the antibiotic to which the patient was previously exposed. However, CDI should usually be treated with an appropriate course (about 10 days) of treatment, including oral vancomycin or fidaxomicin. […] EPA-registered disinfectants with a sporicidal claim have been successful in environmental surface disinfection of patient-care areas where surveillance and epidemiology indicate ongoing transmission of C. diff. […] C. diff is a germ that causes diarrhea and colitis (inflammation of the colon). It can be life-threatening.

• #143 C. Diff Infection: Symptoms, Causes, Diagnosis and Treatment

  https://www.webmd.com/digestive-disorders/clostridium-difficile-colitis

  Ask your health care professionals to wash their hands thoroughly before and after caring for you. […] Request that all medical equipment be sanitized before being brought into your room. […] Wash your hands with soap and water after using the bathroom and before eating. […] Another way to help prevent C. diff is to avoid unnecessary antibiotics. Talk this over with your doctor and see if there are other treatment options. And don’t take antibiotics without a doctor’s OK. […] Many C. diff infections are mild and short-lived, but others can be quite serious. Take precautions, and don’t hesitate to seek medical help if you have symptoms. […] […] […] Clostridioides Difficile FAQs […] Clostridioides difficile is a very contagious bacterial infection that causes symptoms such as frequent watery diarrhea, abdominal cramping, nausea, fever, blood in your stool, and a rapid heartbeat. C. diff usually occurs after a course of certain antibiotics, known as broad-spectrum antibiotics, which kill good and bad bacteria in your gut and allow C. diff to take over. Risk factors for C. diff include being over age 65; a stay in a hospital, nursing home, or long-term care facility where treatment with antibiotics is common; and a history of previous C. diff infection. Severe C. diff can cause serious complications. If you’ve recently taken a course of antibiotics, see your doctor if you have watery diarrhea for more than a couple of days, develop a fever, or have severe cramping and abdominal pain.

• #144 Clostridioides difficile infections (C. diff, CDI) | Disease Outbreak Control Division

  https://health.hawaii.gov/docd/disease_listing/clostridium-difficile-infections-c-diff-cdi/

  Healthy people usually do not get CDI, however the following will increase the risk of developing CDI: taking antibiotics, proton pump inhibitors (medications to help acid reflux or gastroesophageal reflux disease), recent stay at a hospital or nursing home, a serious underlying illness or weakened immune system (such as with HIV/AIDS, cancer, or organ transplant patients taking immunosuppressive medications), advanced age (65 or older), previous infection with C.diff or known exposure to the germs. […] Poor prescribing practices put patients at risk for CDI. More than half of all hospitalized patients will get an antibiotic at some point during their hospital stay, but studies have shown that 30-50% of antibiotics prescribed in hospitals are unnecessary or incorrect. Additionally, rapidly identifying patients with CDI and using appropriate infection control recommendations can of preventing CDI transmission.

• #145 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Clostridium-difficile.aspx

  Moreover, people who have undergone abdominal surgeries or gastrointestinal diagnostic procedures are more susceptible. […] Age is another important risk factor for C. diff infection. […] A previous history of C. diff infection can increase the risk of recurrence by up to 20%. […] The infection is primarily treated by antibiotics; however, in some very severe cases, surgery is performed to remove the affected part of the intestine. […] The most important measure to prevent C. diff infection is to stop unnecessary use of antibiotics.

• #146 What Is C. Diff? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/c-diff/guide/

  Yet in people with weakened immune systems or recent antibiotic use, for example, C. diff can lead to illness from the release of toxins that attack the lining of the organ. […] Although people with no known risk factors can get a C. diff infection, certain things increase your risk, including the heavy use of antibiotics for the treatment of long-term infections. These antibiotics can disrupt the normal makeup of the gut microbiome the community of microbes living in the intestines allowing C. diff to grow out of control and cause an infection. […] Risk factors also include older age, having a severe underlying disease such as inflammatory bowel disease (IBD) or colorectal cancer, or having a weakened immune system. […] In addition, the use of proton pump inhibitors (PPIs), a type of medicine that reduces stomach acid and treats acid reflux, also may increase your risk of C. diff infection. […] Most C. diff infections occur in people who are or who have recently been in healthcare facilities such as hospitals, nursing homes, and rehabilitation centers. In these facilities, germs spread easily, antibiotic use is common, and patients are particularly vulnerable to infection.

• #147 C. difficile (Clostridioides difficile) | Gouvernement du Québec

  https://www.quebec.ca/en/health/health-issues/a-z/clostridium-difficile

  C. difficile infection is caused by the C. difficile bacterium, which multiplies and produces toxins. They irritate the colon, which causes intestinal problems, including C. difficile-associated diarrhea (CDAD). […] In most cases, taking certain antibiotics is the major cause of developing the infection. Taking antibiotics, although required to treat infection, disrupts all the microbes in the intestine, the good ones as well as the bad ones. Given that this natural barrier is weakened, it is easier for C. difficile to enter the colon and cause infection.

• #148 How is C. Diff Spread? Understanding Transmission and Preventing Contagion of C. Difficile Infections

  https://www.qualityinsights.org/quality-quest/how-is-c.-diff-spread-understanding-transmission-and-preventing-contagion-of-c.-difficile-infections

  Clostridioides difficile, or C. diff, is a very contagious bacteria that can cause serious infections, especially in healthcare settings. […] C. diff normally lives in the stomach and intestines, but under certain conditions it can grow and produce toxins that cause symptoms like severe diarrhea and stomach pain. […] Several factors increase the risk of C. diff infections, including: […] Taking antibiotics disrupts the natural balance of good and bad bacteria in the gut. People are 7 to 10 times more likely to get C. diff while on antibiotics and during the month after (Source: CDC). […] C. diff mainly spreads through contact with stool. The bacteria can get on surfaces, and if someone touches these contaminated items and then touches their mouth, they can swallow the bacteria and get infected. […] Yes, C. diff is very contagious. Coming into contact with surfaces or materials that have C. diff spores can spread the infection. […] Effective infection control and hygiene practices are critical in preventing the spread of C. diff, both in healthcare facilities and at home.

• #149 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  C. difficile is the most commonly recognized cause of infectious diarrhea in healthcare settings. […] The emergence of the virulent, epidemic ribotype 027 strain was associated with increased incidence, severity, and mortality during the mid-2000s and resulted in outbreaks across North America. […] The recent isolates of the 027 strain are more highly resistant to fluoroquinolones compared to historic strains of the same type. […] The risk of CDI increases with the length of stay, the most appropriate denominator for HO-CDI rates is the number of patient-days. […] The most important modifiable risk factor for the development of CDI is exposure to antibiotic agents. […] The disruption of the intestinal microbiota by antibiotics is long-lasting, and risk of CDI increases both during therapy and in the 3-month period following cessation of therapy. […] Advanced age, potentially as a surrogate for severity of illness and comorbidities, is one of the most important risk factors for CDI. […] The potential role of asymptomatically colonized patients in transmission has recently been highlighted.

• #150 Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection

  https://www.mdpi.com/2076-2607/12/5/1004

  CDT induces an increased local and systemic inflammatory response in the host and enhances the disruption of the host defense mechanisms caused by TcdA and TcdB. CDT triggers an inflammatory response in the host by suppressing the protective eosinophils of the colon and blood through the indirect induction of eosinophil apoptosis. […] CDI is typically treated with antibiotics, with vancomycin, metronidazole, and fidaxomicin being the recommended choices for both primary and recurrent cases. However, the prolonged use of antibiotics may cause antibiotic resistance and microbiota disruption, which predispose to recurrence. These limitations highlight the need for novel and effective management strategies. […] Contemporary therapeutic approaches to CDI primarily focus on targeting the toxins produced by C. difficile. Research interest has therefore centered on developing new therapies that aim to neutralize these toxins, addressing the effects of toxins that are not tackled by current antibiotic-based treatment regimens. Toxin-based therapies not only help in treating the infection but also promote the preservation of the host’s microbiota. Additionally, vaccination against toxins offers protection against CDI by activating the immune system to defend against the development of the infection.

• #151 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by SHEA/IDSA

  https://www.idsociety.org/practice-guideline/clostridium-difficile/

  A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. […] Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs.

• #152 Clostridium difficile and the Disease It Causes | Springer Nature Experiments

  https://experiments.springernature.com/articles/10.1007/978-1-60327-365-7_2

  Clostridium difficile is a spore-forming, toxin-producing, anaerobic bacterium abundant in soils and water. Frequent and early colonization of the human intestinal flora is common and often asymptomatic. Antimicrobials given commonly disrupt the intestinal microflora and through proliferation in colon and production of toxin A and B it precipitates C. difficile infection (CDI). […] Infection is acquired from an endogenous source or from spores in the environment, most easily facilitated during hospital stay. In the elderly, comorbidity, hospitalization and antimicrobial treatment present as major risk factors and the slow recolonization of the normal flora likely responsible for single or multiple recurrences of CDI (2550%) post therapy. […] Today we experience a tenfold increase of CDI incidence in the western world and both epidemics and therapeutic failure of metronidazole is contributing to morbidity and mortality. The current epidemic of the C. difficile strain NAP1/027 emerging in 2002 in Canada and the USA has now spread to most parts of Europe and virulence factors like high toxin production and sporulation challenge the therapeutic situation and cause great concern among infection control workers. Excessive use of modern fluoroquinolones is thought to play an important role in facilitating this epidemic since NAP1/027 was shown to have acquired moxifloxacin resistance compared to historical strains of the same genotype.

• #153 Clostridioides difficile infection | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/19632

  The emergence of the newer, hypervirulent, antibiotic-resistant, epidemic strain ribotype 027, commonly known as NAP1/B1/027 or the North American pulsed-field gel electrophoresis type 1 strain, restriction endonuclease analysis type B1, or polymerase chain reaction ribotype 027 is characterized by increased production of toxins A and B, as well as the production of a binary toxin CDT, and fluoroquinolone resistance. […] The link between antibiotics and the onset of C difficile infections stems from the dysbiosis within the gut microbiome ecosystem induced by antibiotic use. […] C difficile is ubiquitous and can colonize the intestines of up to 3% to 5% of healthy individuals without causing infections. […] Antibiotics alter the microbial balance in the large intestine, increasing susceptibility to C difficile infection, which is transmitted through the fecal-oral route.

• #154 Clostridioides difficile Infection: Update on Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2020/0201/p168.html

  Antibiotic use is the most widely recognized risk factor for C. difficile infection, and longer courses further increase the risk. Any antimicrobial agent can cause C. difficile infection, but clindamycin is the most common. Other risk factors include severe illness, being older than 70 years, gastric acid suppression, enteral feeding, gastrointestinal surgery, small bowel obstruction, obesity, hematopoietic stem cell and solid organ transplantation, inflammatory bowel disease, cirrhosis, being peripartum, chronic kidney disease, hyperglycemia, hypoalbuminemia, and leukocytosis. […] A recent retrospective cohort study of adults with C. difficile infection in the Veterans Health Administration found that 60% of cases were diagnosed after more than two days of hospitalization; these were classified as health care facility-acquired infections. The remaining 40% were community-acquired infections, and on average 62% of these were associated with antibiotic use.

• #155 What Is C. diff? Symptoms, Causes, and Treatments Explained – BuzzRx

  https://www.buzzrx.com/blog/what-is-c-diff

  Other known risk factors for C. difficile infections are healthcare settings, such as hospitals, long-term care facilities, and nursing homes. These are places where antibiotic use is common, and germs can spread easily. […] However, C. difficile infections can also occur without antibiotic use and outside hospitals and care settings. Some strains of the bacteria that can cause serious infections are more likely to infect younger people. […] The risk increases with each subsequent infection. People who have had three or more C. difficile infections have a more than 50% risk of having another one. […] C. diff germs are mainly transmitted from feces (stool) to the mouth. After the bacteria enter the body through the mouth, they start multiplying in the small intestine. When they reach the colon (large intestine), they release toxins and cause damage, resulting in severe diarrhea.

• #156 Recurrent C. Diff Infections – Symptoms, Causes, Prevention, Treatment

  https://guides.clarahealth.com/recurrent-c-diff-infections/

  The rate of repeat infection varies from 5% to 50% among patients with a resolved first infectionthe recurrence rate varies according to risk factors like age, exposure to hospital environments, and an underlying disease like kidney failure. However, the typical recurrence rate among patients is approximately 20%. […] Among patients who have already experienced a C. diff infection twice, the rate of reinfection is approximately 45% to 65%. […] Be aware that antibiotics can negatively impact the gutbroad spectrum antibiotics can kill healthy bacteria increasing susceptibility to a repeat C. diff infection. […] For example, over 60% of cases of healthcare related C. diff infection cases may have began in long term care facilities.

• #157 Biliary Tract Disorders, Gallbladder Disorders, & Gallstone Pancreatitis | ACG

  https://gi.org/topics/c-difficile-infection/

  While antibiotics are effective in treating most cases of CDI, the symptoms recur after the end of treatment in 10-20% of cases. This is called recurrent CDI and usually occurs 1–2 weeks after stopping treatment. After a recurrence, the chance of further recurrences goes up to 40-60%, perhaps because one is using an antibiotic to treat a disease caused by antibiotics. We presume that the normal colonic bacteria have not had a chance to recolonize. Current recommendations for the treatment of recurrent CDI include a vancomycin taper over six to eight weeks or fidaxomicin for ten days. Bezlotuxumab is a recently approved drug to prevent recurrent infections and is given as a one-time IV infusion during a course of antibiotics for CDI. The most effective treatment, however, is fecal microbiota transplant (FMT). FMT is typically administered via colonoscopy where stool from a healthy donor is instilled into the colon of a patient with recurrent CDI. In studies, it has been effective in over 90% of patients who received the treatment, and has been proven effective with several randomized controlled trials. There are ongoing clinical trials using oral encapsulated forms of FMT, which are the future of this “drug.”

• #158 Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection

  https://www.mdpi.com/2076-2607/12/5/1004

  CDT induces an increased local and systemic inflammatory response in the host and enhances the disruption of the host defense mechanisms caused by TcdA and TcdB. CDT triggers an inflammatory response in the host by suppressing the protective eosinophils of the colon and blood through the indirect induction of eosinophil apoptosis. […] CDI is typically treated with antibiotics, with vancomycin, metronidazole, and fidaxomicin being the recommended choices for both primary and recurrent cases. However, the prolonged use of antibiotics may cause antibiotic resistance and microbiota disruption, which predispose to recurrence. These limitations highlight the need for novel and effective management strategies. […] Contemporary therapeutic approaches to CDI primarily focus on targeting the toxins produced by C. difficile. Research interest has therefore centered on developing new therapies that aim to neutralize these toxins, addressing the effects of toxins that are not tackled by current antibiotic-based treatment regimens. Toxin-based therapies not only help in treating the infection but also promote the preservation of the host’s microbiota. Additionally, vaccination against toxins offers protection against CDI by activating the immune system to defend against the development of the infection.

• #159 Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection

  https://www.mdpi.com/2076-2607/12/5/1004

  While antibiotics are common treatments, high recurrence rates necessitate alternative therapies. Bezlotoxumab, targeting TcdB, is the only available anti-toxin, yet limitations persist, prompting ongoing research. This review highlights the current knowledge of the structure and mechanism of action of C. difficile toxins and their role in disease. By comprehensively describing the toxin-mediated mechanisms, this review provides insights for the future development of novel treatment strategies and the management of CDI. […] C. difficile is classified by the Centers for Disease Control and Prevention (CDC) as one of the top five urgent threats to human health. Historically healthcare-associated, CDI shows an alarming rise in community-acquired cases with approximately 780,000 infections and 49,000 deaths annually in Europe and the United States. These data emphasize the significance of CDI as a public health problem, compounded by its economic burden, exceeding USD 3 billion in Europe and USD 800 million in the United States annually.

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