C. difficile Infection (CDI)

What is Clostridioides difficile?

Clostridioides difficile, or C. difficile, is a bacterium that is found in the environment and can naturally live in the gut. Approximately 3% of healthy adults and up to 60% of infants have C. difficile in their gut, without causing any harm. In some case, however, C. difficile can cause infection.

Why does C.difficile cause infection?

C. difficile bacteria enter the body through the mouth and grow in the bowel. In healthy people, C. difficile bacteria live in balance with many “good bacteria” in the bowel and do not pose a health risk. Sometimes, the balance can be disrupted (for example, when taking antibiotics or chemotherapy to treat other illness), allowing C. difficile to grow to unusually high levels and produce toxins. These toxins can damage the bowel and cause diarrhea.

What are the symptoms of Clostridioides difficile infection (CDI)?

The symptoms of CDI may include mild or severe diarrhea, fever, abdominal cramping, abdominal pain, loss of appetite, nausea, and dehydration. In rare cases it can be fatal.

What are the risk factors for CDI?

C. difficile mostly affects people with:

• Underlying diseases
• Weakened immune systems
• Intensive care stays
• Prolonged hospital stays
• Treatment with broad-spectrum antibiotics
• Age 65 years or more

How is CDI diagnosed?

A sample of your stool will be requested by your doctor, which will be tested in a laboratory for the presence of C. difficile toxins.

How is CDI treated?

Treatment for CDI is determined on a case-by-case basis, depending on the severity of symptoms. Patients who have mild symptoms may not need any treatment, while those who suffer more severe symptoms may require antibiotics and sometime surgery. An emerging treatment for patients with recurring CDI is fecal microbiota transplant (FMT)

How does CDI spread?

C. difficile and their spores are present in stool of a person with CDI. The spores can live outside of body for weeks or months. Other people can become infected if they touch a surface (such as countertops, toilets, door handles, bedlinens, and bedpans) contaminated by C. difficile with their hands, and then touch their mouth without properly washing their hands. Soiled hands can also continue to spread CDI to other surfaces and people.

What happens if I get CDI while I’m a patient in the hospital?

Contact precautions are taken by health care providers to contain the spread of the bacteria. Frequent hand washing and cleaning the surrounding area can help individuals protect themselves from infection and decrease the risk of passing the infection to others.

What can I do to prevent CDI?

The best way to stop the spread of C. difficile is to regularly wash your hands with soap and water or use hand sanitizer, especially before eating and after using the toilet. Regular cleaning of your personal environment, and using antibiotics only when they are needed (and according to your doctor’s instructions) can help you and your family stay healthy.

Why do hospitals sometimes experience CDI outbreaks?

Hospitals take many measures to prevent the spread of C. difficile, such as keeping the environment as clean as possible (especially around ill patients), maintaining good hand hygiene before and after contact with patients, and using antibiotics wisely. However, it’s impossible to eliminate C. difficile completely from the hospital. The C. difficile bacteria can be found in about one of every 30 healthy people, who do not have symptoms of CDI, and its spore form is very difficult to kill. Even if every surface in the hospital is cleaned every day, C. difficile would be continuously reintroduced by new patients coming into the hospital. Furthermore, people in the hospital are generally sicker and are at-higher risk of getting infections than people in the community. Some patients need antibiotics to treat infections, but those antibiotics also destroy the “good bacteria” in their guts and increase the risk of developing CDI.

Annual Report

Annual Surveillance Report for the fiscal year 2018-2019

Population under surveillance

The population under CDI surveillance includes inpatients admitted to BC acute care facilities. This includes patients admitted to the emergency department awaiting placement (e.g. patients admitted to a service who are waiting for a bed), patients in alternative level of care beds, and patients in labour and delivery beds.

Outpatient visits to acute health-care facilities, patients in extended care beds housed in acute health-care facilities, patients in psychiatric beds, and short-term emergency room admissions are excluded. Infants under one year of age are also excluded from this surveillance.

The surveillance protocol for CDI can be downloaded as a PDF document