Clostridioides (Clostridium) difficile background
Clostridioides (Clostridium) difficile Toolkit for Long-term Care Facilities

What is C. difficile?

C. difficile, often referred to as C. diff, is a gram positive, anaerobic, spore-forming, toxigenic bacterium that was first recognized as a cause of disease in 1978. It can be present in the normal flora of the human digestive system. The bacterium has two forms: its vegetative form, which causes disease and generally cannot survive in the environment for more than 24 hours; and its dormant spore form, which does not cause disease but can persist in the environment for prolonged periods.

C. difficile infection clinical information

The severity of C. difficile infections (CDI) ranges from uncomplicated diarrhea to pseudomembranous colitis and toxic megacolon, which can lead to sepsis and death. C. difficile colitis occurs when the gut bacterial equilibrium is disturbed, often by antibiotic use.
Risk factors for acquiring CDI include:

• exposure to antimicrobial therapy (particularly beta-lactam agents)
• gastrointestinal procedures
• advanced age
• immunocompromising conditions
• serious underlying illness
• long length of stay in health care settings
• indiscriminate use of antimicrobials

Antimicrobials most frequently associated with increased risk of C. difficile include third generation cephalosporins, clindamycin, vancomycin, and fluoroquinolones. Restricting the use of antimicrobial agents has been the most successful measure to prevent the development of CDI.

• C. difficile Clinical Information
  Additional information about CDI risk factors, signs and symptoms, transmission, and diagnosis.

Incidence

Along with carbapenem-resistant Enterobacteriaceae (CRE) bacteria and drug-resistant Neisseria gonorrhoeae, C.diff was chosen by the Centers for Disease Control and Prevention as a threat level “urgent” pathogen. One study estimated that one out of every 50 residents aged 65 or older in a long-term care facility (LTCF) was diagnosed with C. diff.

Due to age-related immunity factors and frequent antimicrobial exposure, the elderly are at increased risk for developing CDI.

• While nearly half of CDI cases occur in people younger than 65, more than 90% of deaths occur in people 65 and older.
• Annually in the United States, CDI is linked to 29,000 deaths and at least $1 billion in extra health care costs.
• It is the most common cause of health care-acquired diarrhea in the long-term care setting.
• It represented 12.1% of all health care-associated infections in 2011.
• In Minnesota, the C. diff incidence rate was 202 out of every 100,000 people overall, but three times higher in people 65+ years old.