Clinical guidelines for the management of clostridium difficile associated diarrhoea (CDAD)
What is Clostridium difficile (C diff for short)?
C diff is a bacterium that is found in the gut of up to 3-5% of the population and can be found in the environment. It is the main cause of antibiotic associated diarrhoea.
What are the symptoms?
The effects of C diff can vary from nothing, to watery diarrhoea of varying severity and more rarely to severe inflammation of the bowel.
Who is at risk from C diff?
Antibiotic use is by far the commonest risk for developing C diff although enemas and / or gut surgery also increase the risk. Over 80% of cases are reported in hospital inpatients that are over 65 yrs old. Immunocompromised patients are also at risk. Children under the age of 2 are not usually affected. Staff and visitors do not get C diff.
How do we diagnose C diff?
The most reliable method of confirming that a person has C diff is by examining a sample of faeces in the laboratory. It will usually take 1-2 working days for the result to be available. C diff does have a distinctive odour. This, combined with the symptoms will sometimes indicate a positive diagnosis and the specimen will be sent to confirm this.
How is C diff treated?
C diff can be treated with specific antibiotics. There is a risk of relapse in 20-30% of patients and other antibiotics may be tried. Most cases of C diff make a full recovery. However, elderly patients with other underlying conditions may have a repeat episode.
How can we reduce the risk?
There are three ways of reducing the risk –
- Keep the environment clean
- Wash hands regularly
- Avoid overuse of antibiotics
The C diff lifecycle - click on the image to see a larger version
