Clostridioides difficile

pronounced:

klos-TRID-e-OY-dees dif-uh-SEEL or C. difficile

is a bacterium (germ) that can cause a serious and potentially life-threatening infection associated with symptoms ranging from diarrhea to severe intestinal infections.1,2

C. difficile bacteria can be anywhere and persistent.

The spores are found throughout the environment in soil, household objects such as bathroom fixtures, human and animal feces, and in contaminated food products.1,3,4,5 They have the ability to exist and spread in an inactive state known as spores, which are highly resilient and easily transmissible.6,7

C. difficile spores are resistant to heat and other common cleaning agents like detergents and alcohol-based hand sanitizers,7,8 and the bacteria can persist on hard surfaces for up to five months.9,10

C. difficile infection (CDI) is unpredictable and can occur in anyone, particularly adults.

CDI disproportionately affects older adults and represents an important health burden in adults 65 years of age and older.11

Nearly two thirds of cases occur in individuals over 65 years of age, and one out of 11 US adults aged 65 and older with healthcare-associated CDI will die within one month of diagnosis.12,15

CDI can be a debilitating and potentially deadly disease.

Common symptoms of CDI include watery diarrhea more than three times a day;1,13  abdominal tenderness or pain; fever; nausea; and loss of appetite.1,14​​​​​​​

Severe symptoms may include swelling or inflammation of the large intestine, toxic megacolon (a rare yet life-threatening complication of severe colon disease or infection), and in some cases may even result in death.1​​​​​​​

Explore the resources below to learn more about C. difficile, and visit CDC.gov for additional information.

Animated Video

An animated video explaining what C. difficile and CDI are, as well as the risk factors and burden of the disease.

1 . Mayo Clinic. C. difficile Infection. https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691. Accessed on May 2020.

2.  Centers for Disease Control and Prevention (CDC). Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.

3.  Curry SR. Clostridium difficile. Clin Lab Med. 2010; 30(1), 329-42. doi: 10.1016/j.cll.2010.04.001.

4 . DePestel DD, Aronoff DM. Epidemiology of Clostridium difficile Infection. J Pharm Pract. 2013; 26(5):464-475. Doi: 10.1177/0897190013499521. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4128635/pdf/nihms610787.pdf.

5.  Janezic S, Potocnik M, Zidaric C, et al. High divergent Clostridium difficile strains isolated from the environment. Plos One. Nov. 23, 2016. https://doi. org/10.1371/journal.pone.0167101.

6.  Cohen SH et al. Infect Control Hosp Epidemiol. 2010;31:431-455.

7.  Cole SA, Stahl A. Persistent and recurrent Clostridium difficile colitis. Clin Colon Rectal Surg. 2015;28(2);65-69. doi:10.1055/s-0035-1547333. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442717.

8.  Mullish BH, Williams HR. Clostridium difficile infection and antibiotic-associated diarrhoea. Clin Med (Lond). 2018;18(3):237–241. doi:10.7861/ clinmedicine.18-3-237.

9 . Fawley WN, Underwood S, Freeman J, et al. Efficacy of hospital cleaning agents and germicides against epidemic Clostridium difficile strains. Infect Control Hosp Epidemiol. 2007;28:920-925.

10. Gerding DN, Muto CA, Owens RC Jr. Treatment of Clostridium difficile infection. Clin Infect Dis. 2008 Jan 15;46 Suppl 1:S32-42. doi: 10.1086/521860. https://www.ncbi.nlm.nih.gov/pubmed/18177219.

11. Pechal A, Lin K, Allen S, Reveles K. National age group trends in Clostridium difficile infection incidence and health outcomes in United States Community Hospitals. BMC Infectious Diseases. 2016;16(1),682.doi:10.1186/s12879-016-2027-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114740.

12. Centers for Disease Control and Prevention (CDC). C. difficile Factsheet. https://www.cdc.gov/cdiff/pdf/Cdiff-Factsheet-508.pdf. Accessed May 2020.

13. Centers for Disease Control and Prevention (CDC). What is C. diff? https://www.cdc.gov/cdiff/what-is.html. Accessed May 2020.

14. Centers for Disease Control and Prevention (CDC). FAQs for Clinicians about C. diff. https://www.cdc.gov/cdiff/clinicians/faq.html#anchor_1529601716735. Accessed May 2020.

15. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372:825- 834. DOI: 10.1056/NEJMoa1408913.

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