Clostridium difficile It’s Like Seeing a Train Coming…and You Can’t Get Off of the Tracks

Posted on by DHQP
CDC Vital Signs. Learn vital information about stopping C. difficile infections. Read CDC Vital Signs
CDC Vital Signs. Learn vital information about stopping C. difficile infections. Read CDC Vital Signs

Author – Clifford McDonald MD
Prevention and Response Branch Chief
CDC’s Division of Healthcare Quality Promotion

Looking back now, it is like a movie playing out in my mind. We were at the 2004 IDSA conference in Boston, and my colleagues from the CDC lab, Dr. Dale Gerding’s laboratory, other scientific collaborators, and I were presenting on a new strain of Clostridium difficile called NAP1. I’m not sure everyone understood the implications. Some realized NAP1 could be big; others felt that C. diff wasn’t that big of a deal. For me, it was like seeing a train coming, and you can’t get off the tracks.

Clostridium difficile infections have been an important part of my career. Upon wrapping up the SARS investigations for CDC in Toronto, I turned my attention to C. difficile, as I sensed there was something going on that needed further investigation. Now, here we are 8 years later, and NAP1, which causes severe infection, is still a major issue in the United States.

C. difficile has become a problem across medical care settings.  So much so that the March issue of CDC’s Vital Signs report highlights these deadly infections. The report shows that C. difficile is causing many Americans to suffer or die. Although other healthcare-associated infections (HAIs) have declined in recent years, C. difficile has climbed to historic highs and remains at unacceptable levels. It also points out that C. difficile is no longer just a problem in hospital settings; these infections are a patient-safety concern everywhere medical care is provided.

However, there is good news — these infections can be prevented. Prevention programs in Illinois, Massachusetts, and New York are all reporting 20% declines in hospital C. difficile infection rates as a result of focused infection prevention efforts.

Looking ahead, I foresee the trend lines in hospitalizations and deaths turning around and coming back down. A realistic, near-term goal is to return C. diff infection rates back to where they were before the arrival of NAP1 (1999). Our long-term goal is to pursue the discovery of new prevention methods, which will continue to move us toward the ultimate goal of elimination. By focusing first on the following, we can get there: 1) use antibiotics carefully, 2) detect C. difficile early, 3) isolate patients who test positive immediately, 4) use gloves and gowns to treat, and 5) when patients transfer to another facility, be sure to let the receiving medical team know if the patient has a C. difficile infection. Facilities can also prevent C. difficile by ensuring the cleaning staff uses an EPA-approved, spore-killing disinfectant to clean rooms where C. difficile patients are treated.

Over the past 8 years as C. difficile has marched on, it has been a formidable foe. But there is reason for real encouragement in our ability to combat it. Today, we have tools that we simply didn’t have available at that time. As a country, we have a new-found ability to mobilize to address these deadly HAIs. We are finally at a place where public health is interfacing with healthcare delivery. As a result, I have real optimism in our ability to combat this adversary.

What is your facility doing to prevent the spread of deadly Clostridium difficile infections?

Posted on by DHQP

21 comments on “Clostridium difficile It’s Like Seeing a Train Coming…and You Can’t Get Off of the Tracks”

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    This is a very long statement, but I do hope you will read it. I am an 83 year young woman. I have seldom been sick throughout my life, but, C.Diff has allowed me to see how deadly C..Diff can be. I had just experienced having a Colonoscapy. I had gone to the hospital because a
    bad fall hitting my head. They did a scan and found all was OK . They told me that I had an infection and that I should have a colonoscapy. I did and was found to have severe diverticulos. After a few days I felt as If i was going to faint during a church service, the next morning I was so sick that I asked that an ambulance take me to ER. They immediately placed me in hospital. I was there for 4 days, then they sent me to a rehab center still with no cause of my problem, t was diagnosed then with CDiff Poor lady in the other bed had been exposed to this for 3 days. I was moved to a room designated for patient were not to be exposed to it. Anyone entering the room was to were rubber gloves and gown and to keep washing their hands.
    I HAVE NEVER BEEN SO SICK IN MY LIFE! Many times I asked God to please take me home to heaven.
    I guess it wasn’t my time yet After about 30 days, when they thought I was free from infection they took me from my room, with my bed , and put me into a room where the patient had been after being placed the same isolation room I had just left??? I caused a very large fuss, saying I would rather sleep on the couch, then
    sleep in that room. The head nurse heard me and told the cleaning crew to wash everything in the room be washed with bleach. They did, I slept thee for a few days longer, was discharged and thought that all was over. Not so. Now I have been experiencing loose bowels and extreme fatigue. I am now going to call my primary to tell her that I am not well enough to keep my appointment with her because do not feel well enough to go there, So, we will then speak over the phone . If I don’t die I will get onto this site again, hopefully to give good news. NR in Florida.


    I’ve heard it takes a long, long time to get back to normal after c Diff. I’m six months out from diagnosis and still have daily diarrhea. When can. Expect normalcy? Taking probiotics daily. Thank you.

    The scourge of C. diff has seen little highlight in the lay-press, but the effects on my patients’ lives has been significant to say the least. There are few experiences in my profession career that compare with the healing effect of FMT for C. diff. colitis.

    When I had C-Diff that was misdiagnosed for many months, I was never isolated. I was treated with Antibiotics and sent directly back home & work. I was never told it was contagious or that I needed to clean my home. I was simply told it was from Antibotics prior. Furthermore, my diagnosis was never put in my medical records. Luckily I kept my Positive result record because my current Gut issues were questioned & my prior diagnosis was not in my records.

    I experienced three bouts of hospital-asssociated CDI (NAP1 strain) that progressed to sepsis and full-blown SIRS with MODS over a period of four months, from November 2016 to March 2017. I was placed in a coma following hypoxemia to my brain and placed on a ventilator. I also had toxic megacolon. I regained consciousness and began breathing on my own approximately 27 days after being placed into a coma, and it took another three months to learn how to speak, walk, and feed myself again. My risk factors included prior hospitalization, antibiotic use, and immunosuppression secondary to cancer and chemotherapy, although the third round of CDI did not require chemotherapy and immunosuppression to precipitate infection and sepsis. Fortunately for me, I was able to keep my colon due to a fecal transplant (at Temple in Philadelphia) and have remained free of C. difficile since then, approximately five weeks later.

    I would strongly encourage anyone battling CDI that they speak with their doctors about a fecal transplant The procedure is still considered investigational by the FDA unless you meet certain clinical criteria, such as repeated treatment with vancomycin and hospitalization for CDI.

    After being prescribed Clindamycin (after a possible allergic reaction to amoxacillin) after dental surgery I developed c-diff three weeks after I finished the medication. Very common after this antibiotic. I wish I would have realized how potent it was. I would have asked for something not quite so strong to try first especially where my infection wasn’t life threatening and I’m still not 100% sure my allergic reaction was to the penicillin. I need to go to an allergist and be tested to be sure. Luckily for me the minute I started experiencing diarrhea I took myself in to my doctor and was sent home with a kit so I could get a sample to the hospital lab. Test results were positive for c-diff and I was prescribed an antibiotic. After reading all the possible side effects from the antibiotic and just not feeling right about taking another antibiotic I decided to not take it. I felt for me I needed to go a different route. So many people are given several rounds of some pretty potent antibiotics to clear this up with marginal success that I just couldn’t do it. Did my research into what can help naturally and started a regimine of fermented foods (kefir, organic natural sauerkraut and sauerkraut juice, some live Probiotics, essential oil [OnGuard] a healthy very nutritious meal replacement shake, apple cider vinegar, enzymes) I started this regimine 6/2/2016. Today is 6/9/2016 and my stools are formed, the cramping went away 2 days into my regimine and I feel so much better than I did a week ago. My c-diff may have been a mild case possibly but I was pretty miserable, watery stools and living in the bathroom. I’m not the same person I was a week ago. I pray my family doesn’t catch this. My bathroom was off limits to everyone else. I’ve kept it cleaned with a bleach solution and removed all soft surfaces in the room (towels, rugs, clothing on hooks) I hope this keeps the germs in check. I just want people to know there might be other options besides more antibiotics. It was a frightening thought for me at first not to do another antibiotic to get rid of this but I know my body and I believed it could heal it’s self if I could just replace the good bacteria that had been wiped out. So far so good. Time will still tell. I feel confident that this was the right thing for me. Listen to your body. You know it best and know that there are some of us out here fighting this a non traditional way and winning!

    Hospitalized for c diff took Flagyl for 14 days finished last pill 2/29/16 @12:30 pm was feeling better, stool never normal, just less frequent. However today 1 st stool formed, Second stool watery and a more foul odor, Freaking out that I’m going to relaspe. Help

    My boyfriend contracted C Diff earlier this year (6 months ago). He has been taking Vancomycin to no avail… Basically the antibiotics keep the C Diff in check temporally…. Now the FMT is the next option. We were expecting a Colonoscopy or a NG implantation… But to our surprise we were told that the donation is purified and placed into capsules and ingested orally. It was also said that the success rate of curing C Diff is approx 93%. On more severe cases a second round of FMT may be necessary. We were also told that no complications were expected after ingestation of the capsules.

    My wife is 36 yrs old, last year in Nov when she was 4 months pregnant, she was hospitalised for fevers but unfortunately contracted c-diff. She was treated but the bug resurfaced and an emergency colostomy was done on xmas eve to remove her severely damaged colon. Then in Feb she had a c-section done because the baby was in distress and in April another emergency surgery was done to remove a blockage that had accumulated in her bowel. She has to go for one more surgery to reverse the colostomy so she does not have to use the bag but she is still experiencing trauma from the 3 surgeries she had in a space of 6 months.

    I am a 66 year old woman who was hospitalized six days with C. Diff. almost two years ago. Until recently I was still experiencing loose stools with incomplete evacuation and a low energy level. The gastroenterologist told me I have “post-C.Diff IBS,” and I took a drug he prescribed (can’t remember the name) for several months with no improvement. I finally discontinued the drug and out of desperation I started putting a few drops of peppermint oil in my drinking water. After a week or so my toilet problems improved dramatically. Coincidence? I don’t know.

    However, I still feel tired and very sleepy. Some days I am too tired to get out of bed. Is this related to IBS?

    Has anyone researched the effects of the stool transplant treatment? More and bigger antibiotics don’t seem to be doing the trick. Is it not true that we all carry Cdiff in our bowels, and the abx simply allow it to flourish? Does the stool transplant (from a family member in the same home) replace bacteria that we are not aware of? Is that why it seems to work more often?

    May want to explore the “stool transplant” option. Does work wonders…check the research. If we can get by the “ick” factor, we may be able to save thousands of lives. Of course, with no one making a profit on medication, no one is really pursuing this option…

    Great comment has become a problem across medical care settings. So much so that the March issue of CDC’s Vital Signs report highlights these deadly infections.

    The facility where I work has strict precautions to protect patients and prevent the spread of C.diff. We use a “contact” protocol. It includes using gowns and gloves when entering an infected patient room, posting a “contact” sign on the door, washing with soap and water, and cleaning with proper disinfectants. Preventing the spread of C.diff infection is a priority at our facility. Trainings and education are routine to help remind us about the importance of preventing the spread of infection.

    Has anyone recommended probiotics for your father? If not, ask about this. Like the recent CDC press release said…antibiotics are the cause and they are also the cure. Unfortunately, they do not always cure C Diff.

    We isolate the patient with the infection. We clean their rooms once daily with specific cleaners to maintain the cleanliness of the room. We wash our hands after every patient contact instead of using hand sanitizers. We use gowns and gloves everytime we might come in contact with the patient or their rooms. We ask that any persons other than the patient that are in the room to wash their hands frequently.

    My dad took antibiotics for pneumonia and then got C. Difficile back in December. He thought he was over it, but we soon found out that he was not. So, more antibiotics! Finally, mid-February, he tested negative. But!!!! Two weeks later, he got sick again – now he is in the hospital – with C. Difficile again. He is 80 years old and he is a sick man. They gave him the top two antibiotics, metronidazole (Flagyl), and vancomycin (Vancocin). Two days after the antibiotics, dad was not getting any better, so they have stopped the vancomycin.

    PRMC in Salisbury, Maryland

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Page last reviewed: March 26, 2019
Page last updated: March 26, 2019