Nearly half a million people in the United States contract Clostridium difficile (C. diff) infections each year.
About 15,000Trusted Source die from the infection annually, according to the Centers for Disease Control and Prevention.
C. diff infection can cause life threatening inflammation of the colon.
Antibiotics and fecal transplantation can treat C. diff infection.
Three months before her wedding in 2012, Christina Fuhrman was hospitalized due to severe diarrhea.
“The day I started feeling sick, I hosted a bachelorette party for my best friend. We were on a boat trip and… I was tired and going to the bathroom a lot. It progressed from… having frequent large bowel movements to me quickly becoming so ill that I was decimating parts of my intestines,” Fuhrman told Healthline.
During her first visit with her primary care doctor, Fuhrman was told she most likely had a virus that would go away in a few days.
However, as she experienced increased pain and more frequent diarrhea over the course of a few weeks, her doctor recommended she visit the emergency room.
At the hospital, she received a diagnosis of Clostridium difficile (C. diff), a bacterium that can cause life threatening inflammation of the colon.
“C. diff used to be a disease that affected old people, so it wasn’t the first thing doctors thought of with me. In fact, in the hospital they tested me for cholera before C. diff,” Fuhrman said.
Dr. Bruce E. Hirsch, attending physician and assistant professor in the infectious disease division of Northwell Health, says C. diff is a peculiar infection.
“In contrast to other infections in which a bacteria invades the body and causes inflammation and the body fights it, and antibiotics help kill it, C. diff is contained inside the large intestine. It stays inside the colon and it makes toxins. Those toxins cause intense inflammation of the colon,” Hirsch told Healthline.
The inflammation causes severe diarrhea, which puts a person at risk for dehydration.
This was the case for Fuhrman. After her diagnosis, she was hospitalized for 4 days and treated with an antibiotic. However, 2 days after her course of antibiotics were done, C. diff returned.
“I was put on antibiotics on and off for 7 months, and as soon as I’d go off, it’d come back raging,” she said.
She was also put on gut rest for 5 days at a time, which meant she couldn’t eat food or drink water. She received nutrients and liquid via an IV.
“I was hospitalized six times for at least a week each time, and I had to go into the GI doctor to get fluids when I wasn’t in the hospital because I was so dehydrated,” Fuhrman said.
She barely made it to her wedding and spent her honeymoon in isolation.
“I was so excited to get married, and wanted to feel beautiful, but instead I was having this degrading cruel sickness. I was spending so much time in the hospital that I had to order my veil and earrings from the hospital bed. Shopping for a dress was extremely difficult because I was so weak,” she said.
What causes C. diff?
While C. diff used to be associated with hospitals and healthcare facilities, Hirsch says physicians are seeing more and more people who acquire it in the community.
“There is C. diff in the local environment, and it does seem to be more widespread than in previous years,” he said.
However, just because a person is exposed to it doesn’t mean they will develop a C. diff infection or colitis, says Jason Tetro, microbiologist and host of “Super Awesome Science Show.”
“C. diff can be a part of our intestines throughout life without causing trouble. But if it happens to get a chance to grow, such as in the case of low diversity, then you may run into troubles. If the type of C. diff happens to also be antibiotic resistant, you are going to be in for a long and hard fight,” Tetro told Healthline.
Hirsch agrees, explaining that the balance of bacteria and other organisms inside the colon determine whether C. diff will cause problems.
“If C. diff is exposed to the colon of a person who just had broad spectrum antibiotics, the local bacteria are markedly diminished, and C. diff can take off and make toxins and cause infection. But if a person has a healthy balance of bacteria — if their gut microbiome is healthy and normal bacteria are present — then C. diff does not get a chance [to colonize],” he said.
Fuhrman believes she was susceptible to infection because she was taking antibiotics prescribed to her by her dentist.
“I started having symptoms of C. diff a week after I took the antibiotics following my dental work,” Fuhrman said. “I was the typical American antibiotic user. My doctor would give me an antibiotic just in case, and I’d take them.”
Hirsch says the antibiotic clindamycin is often prescribed for dental procedures because it’s effective at killing germs inside the mouth that can cause infection.
“Although any antibiotic can cause C. diff, clindamycin is one of the antibiotics that has the greatest risk of causing C. diff because it injures and kills so many important healthy bacteria, leaving the lower GI tract open to infestation if you’re exposed to the C. diff germ,” Hirsch said.
As an infectious disease doctor, he says he uses antibiotics to treat patients daily and believes they’re a powerful tool — but that they can also suppress healthy bacteria the body needs.
“It’s a matter of ecological balance. The constant of giving an antibiotic just to be safe and make sure it’s not a severe bacterial infection is no longer a viable concept, because we are dependent on the healthy bacteria that the human body co-evolved… to be healthy,” Hirsch said.
As a board member of the Peggy Lillis Foundation, he also works to spread the word that while antibiotics are lifesaving, they need to be used appropriately.
“My approach to antibiotics is that they are used only when the benefit of antibiotics outweighs the risk, and that the most focused antibiotics should be used and should be used for the shortest amount of time,” Hirsch said.
What are treatment options for C. diff?
Shortly after Fuhrman’s wedding, she underwent a fecal transplantation. This procedure involves transferring stool from a healthy donor into the gastrointestinal tract of a person infected with C. diff. The stool transfer replenishes good bacteria that’s lacking in the gut.
Fuhrman says the fecal transplant allowed her to completely recover.
“It repopulated my gut. I am better today than I was when I was taking those antibiotics before the infection,” she said.
While Hirsch says the initial treatment for C. diff is the antibiotic vancomycin, he says fecal transplant is an effective type of therapy generally reserved for people like Fuhrman who have had C. diff recur at least three times.
“Approximately 20 to 25 percent of people who are treated with vancomycin may have recurring C. diff. In that circumstance, guidelines from the Infectious Diseases Society of America say to use a prolonged tapering course of vancomycin. If C. diff occurs with three or more reoccurrences, then that tells us that the healthy bacteria are not recovering and need support,” Hirsch said.
In these situations, he says fecal transplantation can transfer healthy bacteria to the lower GI tract.
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Can C. diff be removed from the environment?
Once C. diff makes its way into an environment, Tetro says it’s tough to remove due to its ability to make spores.
“They are hard to kill and require at least a 10 percent bleach solution for at least 10 minutes of soaking. The most common areas to find spores happen to be the bathroom and dust accumulated on floors. Thankfully, it seems that the risk to other people slows after a few months, probably due to better hygiene and also treatment of the infected person,” Tetro said.
Fuhrman learned this firsthand when her 22-month old daughter, Pearl, became ill with C. diff.
“A year after my recovery, I gave birth to Pearl. During my [pregnancy], we had bleached our home and cleaned it the best we could. We don’t know how she got it, but the only thing we can think is she got it from our house,” Fuhrman said.
Hirsch says Pearl could have contracted C. diff early on, but it didn’t manifest until months later.
“When we’re born, we don’t have the receptors for the C. diff toxins, so C. diff colonization of a baby’s GI tract is actually very common but doesn’t cause disease until about 2 years of age, when the body develops a receptor… and is able to manifest the colitis,” he said.
In late 2014, Pearl experienced frequent diarrhea, her hair stopped growing, and she became unusually pale. After a series of misdiagnoses, her mom took her to the ER, where she received a C. diff diagnosis.
“She was in full isolation with no food or water for 5 days, just an IV, and she was terrified,” Fuhrman said.
After receiving antibiotics and continuing to decline, Pearl’s dad took her to Mayo Clinic, the closest hospital that would perform fecal transplantation on a child.
The treatment was successful. Today, Pearl is a thriving, healthy 6-year-old girl.
Spreading awareness about C. diff and antibiotic use
Fuhrman started a blog and joined the patient support group Antimicrobial Resistance Fighter Coalition to share her story and educate others about superbugs and antibiotic use.
She’s also traveled to Washington, D.C., to speak with members of Congress about the importance of superbugs and good stewardship practices.
“These superbugs destroy lives, and no one is exempt. My goal as a mom is to educate other moms and caretakers of older and younger people about practicing good stewardship and talking with your doctors about [whether] a prescription is necessary,” Fuhrman said.
Hirsch hopes the public also gains understanding that probiotics, and more importantly, a healthy diet, can help keep the gut healthy and equipped to fight infections like C. diff.
“There are more than 10,000 different types of probiotics on the market. Many of them are not effective or useful, but some are,” Hirsch said.
He says fermented foods contain healthy bacteria and recommends the fermented milk product kefir.
“Nutrition is an important concept. It’s recommended that we get 28 grams of fiber per day, but most of us don’t do that. Fiber is nutrition for our healthy bacteria, and we have to feed [healthy bacteria] in order for them to thrive. If they thrive, we thrive,” Hirsch said.
“Emphasizing a healthy amount of fiber in our diet, particularly when we take antibiotics, is sometimes overlooked,” he added.