Clostridium Difficile

Clostridium difficile also known as C-diff in the medical world or C. difficile in the science world is a bacterium that infects the colon of humans. C-diff belongs to the bacteria Domain. Bacteria are unicellular organisms that contain Peptidoglycan in their cell walls. C-diff is a member of the phylum Firmicutes which means it has a Gram-positive stain and a low guanine and cytosine content. C-diff is also classified as a clostridia meaning it has a lack of aerobic respiration and engages in anaerobic fermentation.

C-diff is from the Clostridiaceae family, is motile, anaerobic, and spore-forming egetative cells are rod shaped, pleomorphic, and occur in pairs or short chains. It is catalase and superoxide dismutase negative, and produces two types of toxins: enterotoxin A and cytotoxin B, which disrupts cytoskeleton signal transductions in the host. (2) For years, doctors have been telling us to only take antibiotics as prescribed and to finish the prescribed antibiotic as directed. This bacterium shows its head when antibiotics have killed the good bacteria in our bodies that fight off bacterium like C. ifficile.

During the several months that the patient’s good bacteria are depleted, they can pick up C. difficile from contaminated surfaces or even a health care worker hands. This bacterium causing inflammation in the colon which is called colitis. The severity of these colitis are classified for best treatment. Mild-to-moderate C-diff is defined as less than six stools per day in the absence of signs of systemic toxicity while severe C-diff is accompanied by a white blood cell count of at least 15 000 cells/? and profuse diarrhea defined by at least six stools per day as well as symptoms of abdominal pain, sepsis, hypotension, and azotemia. (4)

C-diff was first discovered in 1935, but wasn’t known to cause any problems tell research about the problem of antibiotic-associated diarrhea and pseudomembranous colitis lead to the discovery of C-diff causing diarrhea by John Bartlett in 1975. It was also discovered in pigs and calves. No evidence of direct transmission from animals to humans, but indirect transmission can occur via contaminated food. In the colon, the C. diff spores are present in the inactive form.

There are many different bacteria that are typically in the colon and are a part of the normal make up of the colon. These bacteria prevent the activation of the C. diff spores into the active bacterial form. However, when antibiotics are administered for the treatment of an infection, they may kill some of the normal colonic bacteria. This process disrupts the normal balance of gut bacteria and allows Clostridium difficileto become activated and infectious. () C-diff produces toxins that cause disease these two toxins are toxin A and toxin B. Toxin A causes neutropilic infiltration and damage to the colonic mucosa.

Toxin B causes the same damage as toxin A, but has ten times more cytotoxic than toxin A. Roughly 3% of healthy adults are asymptomatically colonized with C-diff. The percentage rises to 50% in patients residing in long-term care facilities an individual’s risk of becoming colonized with C. difficle is directly proportional to length of the hospital stay, with mean time to acquisition of the organism of two weeks. Nearly every antibiotic has been implicated in leading to C-diff, however broad spectrum antibiotics with anti-anaerobic activity appear to cause the greatest risk.

It is important to note that not all antibiotics cause C. difficile colitis, and not everyone receiving antibiotics will develop this infection. Between 1999 and 2004, mortality from CDI increased from 5. 7 to 23. 7 deaths per million people. The most effective way to detect C-diff is looking for toxins in the stool. There are two common drugs used to treat mild to moderate C-diff are metronidazole (500 mg PO TID) and vancomycin (125 mg PO QID) for 10–14 days. The response rates to both drugs have been 95% or better.

The effectiveness of oral metronidazole and oral vancomycin for the treatment of CDI is well supported in the literature, although only vancomycin has received US Food and Drug Administration (FDA) approval for this purpose. Several case reports have noted the use of IV immunoglobulin (IVIG) to induce passive immunity and achieve cure in patients with severe persistent colitis or recurrent disease. Oral metronidazole monotherapy is not an appropriate initial treatment for patients at highest risk, in particular, those who present with significant predictors of disease severity or are of advanced age and have worrisome comorbidities.

There are numerous independent risk factors reported for developing symptomatic disease after acquisition of C. difficile. The risk factors that are most consistently identified in the literature include antibiotic exposure, age > 60 years, longer duration of hospital stay, severe underlying disease, and gastric acid suppression. (2) There is a low risk of transmission of c-diff from person-to-person, although nosocomial transmission from contaminated hands, instruments such as endoscopes, and the environment have been reported.

There are some things that can be done to help prevent the spread of c-diff. Wash your hands often and thoroughly, using soap and water. Use disposable gloves when caring for someone who may have C. diff. Use chlorine bleach-based products to disinfect surfaces or items that may have come in contact with an infected person. Wash clothing that may be soiled with stool with detergent and chlorine bleach. If you are visiting someone in a health care facility, wash your hands before, during and after your visit, especially if you use the restroom facilities.

Don’t use antibiotics unless your doctor recommends them. If you have C. diff. infection, wash your hands with soap and water before eating and after using the restroom. Use a chlorine bleach-based product to clean surfaces you may have touched (doorknobs, telephones or keyboards, for example) to avoid spreading the infection to others. (1) The development of new therapies to treat CDI is of great interest to healthcare providers given the significant morbidity and mortality resulting from CDI and the suboptimal response to currently available treatments.

Metronidazole and vancomycin are the current standard-of-care treatments and fidaxomicin may be increasingly utilized after its recent FDA approval for CDI. The use of antibiotics has benefits, but is it worth the risk? Not only do antibiotics cause c-diff it could cause other complications. “Overuse of antibiotics could be fueling the dramatic increase in conditions such as obesity, type 1 diabetes, inflammatory bowel disease, allergies and asthma, which have more than doubled in many populations,” writes Martin Blaser, a professor of microbiology and chairman of the department of medicine at New York University Langone Medical Center.

Antibiotics have done incredible things and helped a lot of people, but what happens when these antibiotics no longer work. Antibiotic resistance occurs when an antibiotic has lost its ability to effectively control or kill bacterial growth; in other words, the bacteria are “resistant” and continue to multiply in the presence of therapeutic levels of an antibiotic. Some bacteria are naturally resistant to certain types of antibiotics.

However, bacteria may also become resistant in two ways by a genetic mutation or by acquiring resistance from another bacterium. (4) Mutations, rare spontaneous changes of the bacteria’s genetic material, are thought to occur in about one in one million to one in ten million cells. Different genetic mutations yield different types of resistance. Some mutations enable the bacteria to produce potent chemicals (enzymes) that inactivate antibiotics, while other mutations eliminate the cell target that the antibiotic attacks.

Still others close up the entry ports that allow antibiotics into the cell, and others manufacture pumping mechanisms that export the antibiotic back outside so it never reaches its target. Bacteria can acquire antibiotic resistance genes from other bacteria in several ways. By undergoing a simple mating process called “conjugation,” bacteria can transfer genetic material, including genes encoding resistance to antibiotics from one bacterium to another. Viruses are another mechanism for passing resistance traits between bacteria.

The resistance traits from one bacterium are packaged into the head portion of the virus. (3) The virus then injects the resistance traits into any new bacteria it attacks. Bacteria also have the ability to acquire naked, “free” DNA from their environment. Any bacteria that acquire resistance genes, whether by spontaneous mutation or genetic exchange with other bacteria, have the ability to resist one or more antibiotics. Because bacteria can collect multiple resistance traits over time, they can become resistant to many different families of antibiotics. 2)

In conclusion C-diff is caused by antibiotics killing off good bacteria and is seen mostly in people staying in hospitals or other healthcare facilities. Although not everyone gets c-diff from taking antibiotics there are 453,000 cases per year, with 29,300 associated deaths. C-diff is a very terrible disease that is caused by antibiotics, which cure so many other things. What cures one thing may cause another problem. C-diff is an example of when antibiotics can cause real problems.