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What is Clostridium difficile?

Hospital infection guide - Clostridium difficile bacteria on a blood agar plate

Clostridium difficile is a bacterium from the Clostridium family - a group which includes the bacteria causing tetanus, botulism, and gas gangrene.  It is 'anaerobic', meaning that it doesn't grow in the presence of oxygen, but produces spores that can survive for a long time in the environment.  C. difficile bacteria live naturally in the gut (where there is little oxygen) of around five percent of the healthy adult population with the 'healthy' bacteria keeping it under control.  Patients who have been prescribed antibiotics (which destroy the 'friendly' bacteria in the intestines crucial for fighting infection) and the elderly are most at risk, with over eighty percent of reported cases being in the over 65 age group.  


C. difficile causes diarrhoea and can lead to more serious conditions such as bleeding from the colon (colitis) and perforation of the intestine leading to peritonitis.  It occasionally causes death if a person's immune system is too weak to fight off infection.  This can happen if the normal, healthy intestinal bacteria have been killed off by a course of antibiotics and there is no normal bacteria to fight the infection.  C. difficile multiplies in the intestine and produces two toxins - A and B and these toxins damage the cells lining the intestine and cause diarrhoea. 


C. difficile bacteria can survive for a long time and be a source of hand-to-mouth infection.  The bacteria can be passed on via cross infection from another patient, from healthcare staff or from a contaminated environment like the area around a patient's bed (cabinet surfaces, bed pan washers), and toilets.  C. difficile can be treated with specific antibiotics and, if unsuccessful, other treatments may be tried including pro-biotic (good bacteria) treatments to re-establish the balance of flora in the gut.  The HPA say that most cases of C. difficile diarrhoea make a full recovery but elderly patients with other underlying conditions may be more severely affected.  


According to the Department of Health the number of C. difficile cases has increased from under 1,000 in the early 1990s to 55,634 in 2006.  Since January 2004, C. difficile has been part of the mandatory surveillance programme for healthcare associated infections.

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