2020 was a rough year for many of us. But for me, 2021 was the year that said “hold my beer and watch this!” Little did I know at the end of 2020 that I would be diagnosed with a c diff infection that would send me careening into the year 2021 filled with antibiotics, anxiety, pain and uncertainty while fighting the infection for several months. As a nurse practitioner, I knew about c diff, but nothing prepared me for experiencing it! So why should you care? Because you could be next.
What is c diff?
Clostridioides difficile, commonly known as c diff, is a spore-forming bacteria that is found throughout the environment. Spores can be found in air, soil, water, and food, and it can be transmitted by simply touching a contaminated item like a toilet or faucet handle. Spores are little “time bombs” that form when conditions are not right for survival; unlike COVID-19, these spores can withstand extreme changes in temperature, pH, and moisture and are impervious to soap and alcohol (like hand sanitizer). The only thing that kills them is bleach. When conditions are right, spores blossom into living bacteria.
Who gets this nasty bug?
According to the CDC, those most at risk are over 65 years of age, have recently been in a hospital or nursing home, are immune compromised, have recently taken antibiotics, take stomach acid-reducing medications, or have had c diff before. However, it can occur in children and younger adults too, increasingly including pregnant women. As many as nearly 500,000 people get c diff in a given year with an estimated 15,000-30,000 deaths annually. It is the most common hospital association infection. Way back in nursing school, we learned about the dreaded pseudomembranous colitis, a condition associated with certain antibiotics that causes severe painful diarrhea. We now know that is c diff.
MicroWHAT?
What do the c diff risk categories I mentioned above have in common? Potentially an impaired microbiome. Your microbiome is amazing – we carry about 400 strains of bacteria in our colon, most of them helpful. The number of bacteria is in the trillions, higher than the number of cells in your body. A healthy microbiome weighs about 6 pounds, making it the heaviest organ in your body. We nourish our microbiome daily by eating foods rich in fiber and foods that are cultured or fermented – think yogurt, kefir, sauerkraut and kombucha. When the microbiome is damaged it cannot protect us from infection. People who get c diff have a damaged microbiome AND are exposed to c diff spores, usually in a healthcare setting.
How do we get our microbiome?
From the moment we pass through our mother’s birth canal to the times she kisses us (and dad, and Aunt Edna) and we start breastfeeding and eating food, we acquire bacteria. Some of these make their way down into the colon where they set up shop, happily gobbling nutrients along the way and doing some nice things that help us stay healthy like make vitamin K, helps us digest nutrients, promote good immune system function, and facilitate a healthy mood.
What damages our microbiome?
A common cause of microbiome damage is antibiotic use. Antibiotics can be lifesaving but they can also be overprescribed for some conditions. If I had a penny for every time I talked to a patient about antibiotic stewardship, I’d be rich. I’d never have guessed that I would become the example that I gave! You see, while antibiotics are not “one size fits all”, each antibiotic kills a range of bacteria. When you take that Z-pack for your sore throat, it also kills some of your microbiome; there is always collateral damage. Healthy microbiomes usually bounce back after a few weeks. Especially when you’ve taken multiple courses of antibiotics over time, as I had before getting c diff, the damage can lead to prolonged impairment.
How does an impaired microbiome cause infection?
It is partly a problem of ecology: the colonies of bacteria in your colon compete for space and nutrients. When your microbiome is healthy, there is no room for c diff to grow, it is crowded out. Not only that, but some of the healthy bacteria in your gut produce short-chain fatty acids such as butyrate that inhibit the c diff spores from blooming into active bacteria. If you are exposed to c diff spores when your microbiome is damaged, it is easy for c diff to set up shop, blooming into bacteria that colonize your colon.
How do I know if I have c diff?
Here’s the problem: c diff in its bacterial form produces toxins A and B that cause widespread damage to the cells that line your colon and prevent your microbiome from rebuilding. Inflammation causes pain, fever, diarrhea and even shedding of colon tissue. Ouch! Some people have been colonized by c diff. That means they have no symptoms, but they carry c diff and can expose others to it. In one study, 8% of patients admitted to a hospital for some illness had evidence of c diff in their colons and had no symptoms.
How is c diff treated?
Ummm…well, with an antibiotic. A couple of particular ones that are not absorbed in the bloodstream but concentrate in your stool, getting at the bacteria where they live, inside your colon. Unfortunately, these antibiotics also impair your microbiome some. That is party why around 25% of people who get c diff have recurrent infections. It takes time to repair damage to the microbiome and once the antibiotic to treat c diff is stopped, it can come right back. Of us unlucky 25% something like 60% have a third occurrence.
How can I prevent getting an infection?
The best prevention is simply washing your hands after using the toilet. Every time. Shut the toilet lid before flushing it, because toilets aerosolize the spores, spreading them all over your bathroom. . And be careful about antibiotic use. Consume organic meat when possible, as antibiotics are routinely used in some commercial animal feed. I get that we are inconvenienced by illness, it gets in the way of work and school and…life. But asking for pills to get over something quickly leads to the overuse of antibiotics. Trust me, I have seen overprescribed antibiotics often throughout my career. If your provider wants to give you an antibiotic, ask them if there are alternatives. Eat plenty of fermented and cultured foods, food with lots of fiber to feed your microbiome (fruit, vegetables, whole grains, beans) and stay well hydrated. Probiotics are actually a bit controversial as they have not been well studied, but you could hedge your bet with them. Remember that we get probiotics naturally by eating fruits and vegetables, especially organic or home-grown.
Where do we go from here?
C diff is a devastating infection for many, and there is SO much to discuss. I will be posting about c diff over the next several weeks, exploring it in depth, and along the way addressing many other interesting topics involving your health and wellness. Please join me on this trip down the rabbit hole as we examine and discuss, and feel free to offer your suggestions and stories in the comments below.
Resources:
ACG Clinical Guidelines: Prevention, Diagnosis, and Treatmen… : Official journal of the American College of Gastroenterology | ACG (lww.com) last accessed 4/18/2022
Your Risk of C. diff | CDC last accessed 4/18/2022
Definitely need to emphasize the probiotics for a healthy happy gut. Any fermented food that is not pasteurized will help/ Such as sauerkraut, kimchi, kefir, and kombucha – all of which can be made at home. the first two just require salt, water & the vegetables.
the 3rd & 4th one require a starter – which can be gotten from a neighbor or for the cost of shipping.
Hi Dawn! How are you? I’ve been fermenting my own sauerkraut to start with. Gosh, it’s good and so easy and cheap. I’ve been buying fresh kraut at the store for up to $8 a jar. I’m going to try some veges next.
Tell me how…my daughter Katrina has good luck fermenting foods, I haven’t. 😔. Maybe you could write a post on that sometime. So glad you are doing better. Great info. I’ve met many in my cancer journey that have developed c dif during treatment. Thank you for sharing.
It was easy-peasy. All I did was cut up cabbage and mash it into a mason jar, adding a pinch of salt (and caraway seed in my next batch) until the juice from the cabbage covered it. Amazing how much cabbage fits that way. I used my exotic wood Mojito muddler to mash with. Fermenting is on my list of topics. I have about a year’s worth of stuff I plan to write about! Thanks!
Thank you
Very interesting!
I’ve always enjoyed learning more about the body, methods of wellness and healing, so thanks for providing this succinct and interesting piece of writing on c.diff. So unfair, to be in the trenches serving others and find yourself (over)exposed to such risks, eh? Any nurse these days is both brave and self sacrificing, I’d say. Kudos!
My brother, a cancer patient, has Mersa outbreaks. Recently one nearly ended his life. Apparently another infection easily contacted in hospital settings. I’d like to know more about it as well if you wish to share what you know and your experiences with it.
Topic! Thanks I’ll add that to my list. I have managed A LOT of MRSA during my career!
So interesting. I had no actual idea what this was, though I had heard the term. Appreciate the step-by-step explanation of what sounds like a devastating condition. Look forward to reading the next blog for additional information.
I truly understand what c-diff is now! Simple, yet interesting, examples and explanations make it a very enjoyable read. You make it comfortable even though the topic is not.
I guess I should say informative rather than enjoyable. Basically you write as if you are talking to me over coffee.
What a great post, Kathy! I learned a lot! I recently started making my own kefir. 😀
I’m so ready to read your blogs , Kathy. You’re very informative ,& smart and I’m definitely sure you’re going to have amazing blogs
to read !!!
Great explanation! I never really knew what c diff was. (Also great writing!)
I love this fact-full, friendly, C Dif made easy article. I don’t’ need to go much further than this to get the basics of C Diff, as Kathy is a trusted, intelligent source of info. Thanks Kathy! Bravo!
Thank you, Kathy, for a succinct, interesting, and (simply) informative post! While modern medicine has been a miracle in so many respects, C-Diff is the monster it created with overprescribing antibiotics. I’ll pass this post on to patients and friends who are battling what you have (so sorry Kathy!). I was just listening to an interview with Tig Notaro. Before battling breast cancer, she battled a C-Diff infection. She said it so compromised her immune system/general health, that she opted out of chemotherapy (having only surgery) because she felt she wouldn’t survive it. You’re doing great work with this. Thank you!!