Clostridium difficile

C. difficile is a pathogenic bacteria of the gut that can cause severe bloating, abdominal pain and diarrhea and C. difficile infections usually occur in situations where there is an over-use of antibiotics.  Using antibiotics too frequently and inappropriately destroys our normal, harmless gut bacteria and allows room for harmful bacteria to grow.  In this case, over-use of antibiotics allows ingested C. difficile spores to attach, germinate and grow.  C. difficile causes inflammation in the gut by releasing several toxins, two of which are A and B.  These toxins target the intestinal cells and cause damage to the lining of the gut.

When under stress, C. difficile forms spores that are little are smaller, practically indestructible bacteria that lie dormant until activated to grow (or germinate).  Spores are heat resistant and are not killed by alcohol or routine cleaning which makes them particularly dangerous in hospital settings where they can stay viable on contaminated surfaces for long periods.  C. difficile is transmitted from person to person by the fecal-oral route which means a patient must ingest the bacteria or spores to initiate infection. Spores are particularly resistance to stomach acids and pass to the colon where they germinate and become toxin-producing bacteria.  There is some data that some of the commonly-used antiseptics in hospitals may not only have no effect on the bacteria, but may actually promote spore formation and thus make them more difficult to eradicate.

Diagnosing C. difficile infection (colitis) is most effective by examining fecal cultures.  Endoscopy (visual evaluation of the inner lining of the colon using a small camera) is also used but is not as sensitive as fecal culture assays.  Treating C. difficile infection (or colitis) is difficult since some of these bacteria develop antibiotic resistance.  Approximately 20-27% of patients treated with the conventional antibiotics relapse and more drastic treatment is required.  Some doctors are beginning to use fecal transplants (or fecal enemas) to repopulate the normal microflora of the gut and cure the C. difficile infection.