Can C Diff Cause Kidney Problems

How You Get Clostridium Difficile

C. diff bacteria are found in the digestive system of about 1 in every 30 healthy adults.

The bacteria often live harmlessly because other bacteria normally found in the bowel keep it under control.

But some antibiotics can interfere with the balance of bacteria in the bowel, which can cause the C. diff bacteria to multiply and produce toxins that make the person ill.

When this happens, C. diff can spread easily to other people because the bacteria are passed out of the body in the person’s diarrhoea.

Once out of the body, the bacteria turn into resistant cells called spores.

These can survive for long periods on hands, surfaces , objects and clothing unless they’re thoroughly cleaned, and can infect someone else if they get into their mouth.

Someone with a C. diff infection is generally considered to be infectious until at least 48 hours after their symptoms have cleared up.

Treatment For Clostridium Difficile

Your GP will advise if you need hospital treatment .

If the infection is mild, you should be able to recover at home.

If you’re in hospital, you might be moved to a room of your own during treatment to reduce the risk of the infection spreading to others.

Treatment for C. diff can include:

• stopping the antibiotics thought to be causing the infection, if possible in mild cases, this may be the only treatment that’s needed
• taking a 10-day course of antibiotics that are known to kill the bacteria
• rarely, serious infections may require surgery to remove a damaged section of the bowel

C. diff infections usually respond well to treatment, with most people making a full recovery in a week or 2.

But the symptoms come back in around 1 in 5 cases and treatment may need to be repeated.

What Is The Difference Between C Diff Colonization And C Diff Infection

Up to 5% of people in the community, and an even greater percentage of people who are hospitalized, may be colonized with C. diff bacteria, but not experience any symptoms. The risk of progressing to disease varies, since not all C. diff strains produce toxin that makes you sick. People colonized with a non-toxin-producing strain of C. diff may actually be protected from CDI.

CDI is diagnosed based on symptoms, primarily watery diarrhea occurring at least three times a day, and stool that tests positive for C. diff. A positive test without symptoms represents colonization and does not require treatment. Patients colonized with toxin-producing strains are at risk for disease, particularly if exposed to antibiotics.

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So How Do We Prevent C Diff Infections

We cant prevent all infections, but we can reduce the chance of contracting C. diff by only taking prescribed antibiotics and not someone elses, even if you believe you have the same type of infection. Wash your hands frequently and well. And if you suspect you have C. diff, contact your doctor right away.

If you do have a C. diff infection, watch for signs of sepsis. If you think you may have sepsis, seek help immediately by going to your closest emergency room or calling 911.

Learn more about C. diff and other conditions that can lead to sepsis at the library.

Why Is C Diff So Dangerous C Diff Awareness Month

C. diff is an infection caused by Clostridioides difficile, a bacterium that causes diarrhea and inflammation of the colon, called colitis. It used to be called Clostridium difficile. C. diff infections affect almost a half a million people in the U.S. every year. And, if you have C. diff, you have a higher chance 1 in 6 of getting it again within a few weeks.

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Clostridium Difficile Infection In Patients With End Stage Renal Disease Is It Preventable

ukasz Lis

Research and Development Center, Provincial Specialist Hospital in Wrocaw, Poland

Andrzej Konieczny

Research and Development Center, Provincial Specialist Hospital in Wrocaw, Poland

Kinga obicka

Research and Development Center, Provincial Specialist Hospital in Wrocaw, Poland

Wojciech Witkiewicz

Research and Development Center, Provincial Specialist Hospital in Wrocaw, Poland

Zbigniew Hruby

Research and Development Center, Provincial Specialist Hospital in Wrocaw, Poland

DOI: 10.15761/NRD.1000153

Figures & Data

Developments Of The Diagnosis Of Clostridium Difficile

The diagnosis of Clostridium difficile-associated diarrhea was confirmed by ELISA testing for enterotoxin A and B. The diagnosis of an infection with Clostridium difficile can be made either by testing for toxin A or B , bacterial enzymes or by bacterial culture. Bacterial culture is highly sensitive and allows bacterial strain typing, but also takes 2-5 d to perform. Latex agglutination tests are fast and inexpensive and have improved in sensitivity in the past few years.

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If C Diff Is Caused By Antibiotics How Do Antibiotics Treat It

Not everyone who has this infection needs treatment. About 20% of patients see their symptoms disappear just a few days after they stop taking the antibiotic that caused it in the first place. The other 80% need active treatment.

It may seem odd to treat a condition caused by antibiotics with more antibiotics, but since Clostridioides difficile is a bacterium, antibiotics are the only way to treat the infection. At this point, there are only two effective antibiotics, vancomycin or fidaxomicin.

Researchers are looking at a newer treatment called fecal transplantation or bacteriotherapy. Stool from a healthy person is collected and inserted into the infected patients colon, much like a colonoscopy. Another approach is to place the stool in capsules, which the patient swallows.

Fecal transplant is not completely new some hospital systems have been using the treatment since 2012. However, its understandable that a patient may be wary about the procedure, as it is out of the norm. However, a study published in 2013 in the New England Journal of Medicine showed that this approach was more effective than the antibiotic vancomycin in treating repeat C. difficile infection.

What Is Kidney Disease

Your kidneys are responsible for filtering waste and extra fluid from your body. If your kidneys become damaged, fluid and waste can build up and you may experience:

• Swelling in your ankles
• Poor sleep
• Shortness of breath

There are two types of kidney disease. If your kidneys abruptly stop working, which may occur after an accident or from dehydration, this is known as acute renal failure, and its important to seek medical attention right away. If your kidneys are not working for three months or longer, this is categorized as chronic. Diabetes and high blood pressure are the most common causes of chronic kidney disease.

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How Is C Diff Diagnosed

C. difficile

• A stool test
• A CT scan
• A colonoscopy or sigmoidoscopy procedure with a gastroenterologist

A stool test is the most common way to detect C. diff. A pathologist assesses a sample of your stool to determine whether it contains C. diff bacteria.

If a stool test is inconclusive, a blood test may be needed. Blood tests can reveal high levels of white blood cells, a sign of infection, including C. diff.

A colonoscopy allows your doctor to assess the entire colon and rectum, while a sigmoidoscopy provides images of the rectum and the lower part of the colon. Both tests can indicate whether inflammation is present, a telltale sign of a C. diff infection. They also allow your doctor to collect tissue samples from your colon, if needed, to further test them for bacteria.

What Can You Do To Prevent Cdi

Though there are no guarantees, there are many things you can do to help reduce your risk of CDI, particularly if you are scheduled for hospitalization or surgery.

If you are scheduled for surgery, discuss routine antibiotics to prevent infection with your surgeon. In most cases, according to the CDC, one dose of an antibiotic is sufficient. If you have an established bacterial infection, several recent studies show that shorter antibiotic courses are effective and may also reduce your risk of CDI. You should also ask your doctor about avoiding antibiotics that are more likely to result in CDI .

If you are hospitalized with CDI, you should use a designated bathroom and wash your hands frequently with soap and water, particularly after using the restroom. In the hospital, encourage staff to practice hand hygiene in your line of sight, and express appreciation to hospital staff for keeping your environment germ-free. If you are at high risk for a CDI recurrence , discuss the potential value of bezlotoxumab with your provider. This monoclonal antibody can help to further reduce risk of recurrent CDI in those who are at high risk for recurrence.

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How Can C Diff Be Prevented

To prevent a C. diff infection, you can do the following:

• Avoid the unnecessary use of antibiotics.
• Wash your hands thoroughly for at least 20 seconds with soap and water.
• Clean infected surfaces with disinfectants such as bleach in places where someone is known to have C. diff.
• If you have C. diff, close the lid when flushing the toilet, as the spores can travel through the air.

Advanced Ckd Increases C Difficile Infection Risk

AMSTERDAMAdvanced chronic kidney disease is a risk factor for infection with Clostridium difficile according to study findings presented at the 51st Congress of the European Renal Association-European Dialysis and Transplant Association.

Kyung Kyu Kim, MD, and collaborators at Korea University Anam Hospital in Seoul, Korea, compared 171 patients CDI and 342 age- and sex-matched control patients without CDI. Stage IV-V CKD not requiring dialysis and end-stage renal disease requiring dialysis were associated with a nearly 2.9 and 4.9 times increased risk of CDI, respectively.

Among patients with CDI, more advanced CKD was associated with higher in-hospital mortality .

Additionally, the use of 2 or more antibiotics, prior use of vancomycin, the presence of pseudomembranous colitis, elevated white blood cell coutn, high C-reactive protein levels, and advanced CKD stages were significantly associated with poor response to initial metronidazole treatment, according to the investigators.

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Occurrence In The United States

In the United States, C difficile infection occurs primarily in hospitalized patients, causing as many as 3 million cases of diarrhea and colitis per year. Cancer patients are significantly affected by CDI healthcare-associated diarrhea. Diarrhea caused by C difficile is also linked to 14,000 American deaths annually.

The incidence of reported CDI infection continues to increase. In the 1980s, McFarland et al reported that 7% of patients admitted to a hospital and 28% of patients who were hospitalized had positive cultures for the organism. By the 1990s, the incidence of C difficile in hospitalized patients had risen to 30-40 per 100,000 population, and by 2005, to 84 per 100,000 population.

Indeed, in contrast to the incidence rates of other nosocomial infections, which declined from 2000 to 2009, the number of hospitalized patients with any CDI as a discharge diagnosis more than doubled in the same period, from approximately 139,000 to 336,600. Furthermore, the number of patients with a primary diagnosis of CDI more than tripled, from 33,000 to 111,000.

New CDI populations have emerged, and studies have challenged the notion that C difficile is primarily a hospital infection, as more cases are being seen in the community. These cases include patients with community-acquired infection and no previous antibiotic exposure, pregnant women, and patients with inflammatory bowel disease .

Looking After Yourself At Home

If you’re well enough to recover from Clostridium difficile at home, the following measures can help relieve your symptoms and prevent the infection spreading:

• make sure you finish the entire course of any antibiotics you’re prescribed, even if you’re feeling better
• drink plenty of fluids to avoid dehydration and eat plain foods, such as soup, rice, pasta and bread, if you feel hungry
• take paracetamol for tummy pain or a fever
• do not take anti-diarrhoeal medicine, as this can stop the infection being cleared from your body
• regularly wash your hands and contaminated surfaces, objects or sheets
• stay at home until at least 48 hours after your last episode of diarrhoea

Your GP may contact you regularly to make sure you’re getting better. Call them if your symptoms return after treatment finishes, as it may need to be repeated.

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Causes And Risk Factors For C Diff

C. diff

Whats more, this bacterium produces spores that can persist in the environment for a long time.

C. diff

Although people with no known risk factors can get a C. diff infection, certain things increase your risk, including the heavy use of antibiotics for the treatment of long-term infections. These antibiotics can disrupt the normal makeup of the gut microbiome the community of microbes living in the intestines allowing C. diff to grow out of control and cause an infection.

C. diff

• Cephalosporins
• Fluoroquinolones

In addition, the use of proton pump inhibitors , a type of medicine that reduces stomach acid and treats acid reflux, also may increase your risk of C. diff infection.

C. diffC. diffC. diff

Treating Recurring C Difficile Infections

Recurring C. difficile infections may occur because treatment did not completely eliminate the first infection, or because a different strain of the bacterium has started to develop.

Treatment may include:

• probiotics such as S. boulardii, which a person should take alongside antibiotics
• fecal microbiota transplant

Around 40â60% of people experience a recurrence if the first round of treatment is not successful.

C. difficile bacteria can spread easily. However, hospitals and other healthcare establishments can reduce the risk of spread by following strict infection control guidelines.

Visitors to healthcare facilities should:

• avoid sitting on beds

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Clostridium Difficile Infection In The General Population

Clostridium difficile is currently the most frequently identified pathogen causing antibiotic-associated diarrhea and the main cause of nosocomial diarrhea . Clostridium difficile is a Gram-positive, anaerobic spore forming bacillus. The ability to produce spores enables bacteria to survive in the external environment and facilitates infection. The spores are characterized by resistance to high temperatures, acids and antibiotics. Infection is transmitted by the faecal-oral route . After ingestion, the spores being resistant to acid, pass through the stomach into the small intestine where they germinate into vegetative bacterial forms upon exposure to bile acids. The main factor determining the pathogenicity of Clostridium difficile is the production of bacterial toxins A and B which damage the intestinal mucous membrane. Both enterotoxin A and B inactivate Rho GTP-ase, leading to depolymerization of actin filaments and damage to colonic epithelial cells. The presence of these toxins in the intestinal lumen stimulate the synthesis of tumor necrosis factor alpha and proinflammatory interleukins, facilitates neutrophil and macrophage recruitment, increases vascular permeability, causes the opening of epithelial cell junctions and stimulates epithelial cell apoptosis . Damage to the intestinal mucosa and excess mucus production lead to diarrhea, colitis and the formation of a pseudomembrane consisting of inflammatory cells, fibrinous exudates and necrotic cells.

Table 1.

C Difficile Hospitalizations With Acute Kidney Injury Rising

HealthDay News Hospital admissions of patients with Clostridium difficile infection and accompanying acute kidney injury are increasing, according to a study published in the Journal of Gastroenterology and Hepatology.

Paris Charilaou, MD, from Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ, and colleagues used data from the National Inpatient Sample to estimate the effect of AKI on inpatient mortality of CDI patients.

The researchers found that the AKI prevalence was 22%. The overall mortality rate was 8.4%, but was 18.2% among AKI patients.

When propensity matching patients, AKI increased mortality by 86%. From 2003 to 2012, CDI incidence increased by 1.8%, while the rate of AKI increased from 12.6% to 28.8%. Hospitalizations increased over the study period however, mortality decreased from 9.0% to 7.2%.

AKI is a significant contributor to mortality, independently of other comorbidities, complications, and hospital characteristics, emphasizing the need for early diagnosis and aggressive management in such patients, the authors wrote.

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Use Of A Lactobacillus Plantarum 299v In The Prophylaxis Of Clostridium Difficile Infections In The Nephrology Ward

Because CKD patients are characterized by high CDI risk, CDI prevention in these group of patients is of great importance. Among preventative measures against CDI, the use of probiotics should be discussed. So far, it has not been proven in the general population that probiotics are effective in the prevention of CDI in patients undergoing antibiotic therapy. In a meta-analysis of 23 randomized controlled trials, including 4213 patients, Goldenberg et al. showed that probiotics can reduce the risk of Clostridium difficile-associated diarrhea by 64% . However, in another analysis of 13 trials it was showed that there is no significant effect of probiotics on the incidence of CDI . In the randomized placebo-controlled clinical study, PLACIDE , Allen et al. evaluated the role of probiotics in the prevention of CDI prospectively in 2889 hospitalized patients over 65 years of age treated with antibiotics. The study did not show any evidence of the efficacy of the multistrain preparation of lactobacilli and bifidobacteria in the prevention of CDI .

Table 2.

The incidence of CDI before and during Lactobacillus plantarum 299v prophylaxis in the Department of Nephrology, Transplantation and Internal Medicine, University of Silesia. Based on Kujawa-Szewieczek et al. . *P.0001 vs period during LP299v prophylaxis

How Is C Diff Treated

The most common antibiotics used to treat CDI are oral vancomycin or fidaxomicin. Extended regimens, lasting several weeks, have been used successfully to treat recurrences. Vancomycin enemas and intravenous metronidazole, another antibiotic, are also used in severe cases.

Fecal microbiota or stool transplant from screened donors is an effective investigational treatment for those who do not respond to other treatment. However, it is not without risk. FMT capsules are effective and logistically easier.

Patients with severe CDI not responding to therapy may benefit from surgery, typically a colon resection or a colon-sparing procedure.

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