Recovering at Home Can Help to Avoid C. difficile Colitis
Clostridium difficile (C. difficile) is a bacterium that was named in 1935 for the difficulty that scientists had in isolating it.[i] Eighty-five later, C. difficile is anything but difficult to reproduce. It causes an infection of the large intestine known as C. difficile colitis, which is becoming alarmingly common in hospitalized patients and those in other healthcare institutions. The infection can be very serious—in some cases, requiring surgical removal of the colon. Less severe cases can also be very challenging to treat, because the treatment itself predisposes one to developing the infection.
C. difficile colitis is common in hospitals, nursing homes, and other environments in which patients with weakened immune systems are clustered. Antibiotics change the balance of bacteria that naturally exist in the colon, making it easier for C. difficile to flourish. Most cases can be treated with antibiotics that attack the C. difficile bacteria. However, they also affect the “good” bacteria living in the colon, which are part of the body’s natural defense against C. difficile.
Even after a C. difficile colitis infection has been cured, the bacteria typically remain in the intestines—they are simply not numerous enough to overcome the body’s immune system and cause an infection. However, the risk of recurrent infection is high. Roughly 20% of those who have had C. difficile colitis develop the infection again—usually, within four weeks of finishing treatment for the initial bout.[ii] After a second case, the risk of another increases to about 40%; after a third case, to about 60%.[iii][iv] Each bout of C. difficile colitis can require additional hospitalization. It can be something of a self-perpetuating illness.
The risk of developing C. difficile colitis is a compelling reason to limit the duration of time spent in the hospital to that which is truly medically necessary. While C. difficile exists outside of acute care facilities such as hospitals, one is much less likely to develop an infection while recovering at home or in another private setting. Good home care providers routinely clean indwelling catheters, such as IVs and Foleys, with antibacterial fluid, and assure good hand and personal hygiene. Nurses, nursing assistants, and home health aides can also teach other caregivers the simple steps needed to keep you safe from infection while recovering at home.
[i] Kelly CP, Lamont JT. Clostridium difficile—More Difficult Than Ever. N Eng J Med 2008;359;1932-40.
[ii] Wilcox MH, Fawley WN, Settle CD, Davidson A. Recurrence of symptoms in Clostridium difficile infection—relapse or reinfection? J Hosp Infect 1998;38;93-100.
[iii] McFarland LV, Surawicz CM, Greenberg RN, et al. A randomized placebo-controlled trial of Saccharomyces boulardii in combination with standard antibiotics for Clostridium difficile disease. JAMA1994;271:1913-18.
[iv] McFarland LV, Elmer GW, Surawicz CM. Breaking the cycle: treatment strategies for 163 cases of recurrent Clostridium difficile disease. Am J Gastroenterol 2002;97:1769-75.