Clostridium Difficle Infection (CDI) is prevalent in patients due to overuse of antibiotics. It can cause life-threatening forms of diarrhea and colitis.
Due to developing resistance, treatment is becoming very costly. Costs can soar annually up to $4.8 billion in excess health care related expense for acute care facility alone. According to recent statistics, CDI is responsible for more than 250,000 infection cases per year. It also has caused at least 14,000 deaths in that timeframe. More than 20 percent of the population does not respond to initial treatment.
Clostridium Difficle is a common intestinal bacteria, which can form a spore making it more contagious. Because of the spores, it is difficult to treat and can live in the environment for long periods of time. Many people naturally have Clostridium Difficle without illness. Sometimes just taking common antibiotics can kill all the bacteria, except the most resistant one — C. diff. which then causes severe diarrhea. It usually happens in hospitalized patients but can happen in outpatient settings or long term care facilities as well.
Patients usually experience explosive watery diarrhea (at least more than three in 24 hour’s period), fever, abdominal cramps and nausea. Patients taking proton pump inhibitors (PPI) like omeprazole and pantoprazole are at greater risk of CDI.
CDI can spread by hands infected after using bathrooms. Frequent hand washing is necessary between patient visits in hospitals or nursing homes. Hands must be washed with soap and water, not hand sanitizer.
Only one stool sample needs to be tested for C. Diff toxins. Do not repeat testing as confirmation of a cure since stool toxins can remain positive for at least 30 days. The best way to prevent CDI is to minimize the duration of antibiotic therapy, PPI treatment and discontinue stool softeners. Enteric contact precautions are advised for positive patients.
The most common antibiotic used to treat CDI is metronidazole (Flagel). Due to repeated use, it seems to be losing its effectiveness. Oral vancomycin can be an alternate mode of treatment. If these two antibiotics fail then they may require retreatment, more prolonged treatment or different antibiotics altogether. Treatment can become very expensive if the initial antibiotic fails. After multiple relapses, fecal transplant is an option.
Dr. Anis Ansari is a board certified Internist and Nephrologist based in Clinton.