In the following edited Q&A, Carman Ciervo, DO, a family physician at Cooper University Health Care in New Jersey, shares key things to know about C. diff.
What are some of the most common causes of C. diff?
C. diff infections often occur when patients are placed on antibiotics that put them at higher risk, like clindamycin, a drug that is often prescribed following a dental appointment. Dentists tend to use this antibiotic to protect patients from bacteria in their mouths. However, depending on how a patient’s bowels react to clindamycin, and how long they’re on it, it can lead to C. diff.
People, and especially those over 65, who are on antibiotics for other reasons for prolonged periods of time may also be at risk. If you’re experiencing significant diarrhea, the C. diff antigen is one of the things you can ask your physician about, notes Dr. Ciervo.
Why has C. diff become more commonplace?
It has become more common recently with the greater utilization of broad-spectrum antibiotics, which are antibiotics that target many types of bacteria (as opposed to narrow-spectrum, which only target a few).
Think of it like using a nuclear spike missile to kill a bacteria you could kill with a fly swatter, says Dr. Ciervo.
You might see it in hospitals where there isn’t good antibiotic management. If an infectious diseases department isn’t controlling the types of antibiotics that are being used for certain infections, problems often occur.
For example, if a patient comes in with community-acquired pneumonia, rather than having them on a narrow-spectrum antibiotic that attacks the specific range of bacteria, covering most of what needs to be covered, somebody’s being put on a broad-spectrum antibiotic that has the potential to cause an infection.
What is the current recommended treatment for C. diff?
If it’s a patient’s first C. diff episode, an oral antibiotic is recommended. If it’s a second episode, physicians are going to treat it for a longer period of time, and start with an antibiotic called fidaxomicin.
When it comes to a point where someone is having multiple bouts and it’s just not stopping, and it’s affecting their life and overall health due to lost weight and body mass, a doctor may recommend a fecal microbiota transplant. That is when stool with healthy bacteria is transferred into the colon of the infected patient to promote a natural protective response. At this point, a primary care physician would refer a patient to a gastrointestinal or infectious diseases specialist.
How does COVID-19 play a role in the importance of C. diff awareness?
During the pandemic, physicians may not be seeing patients in person as much since so many visits are via telehealth. As a result, physicians may be erring on the side of prescribing stronger, broad-spectrum antibiotics. That tendency is even more of a reason to have awareness of C. diff.