The Long-Term Effects of C. Diff
Medically reviewed by Robert Burakoff, MD, MPH
"C. diff " is a shortened name of a type of infectious bacteria called Clostridioides difficile (formerly known as Clostridium difficile). This is a germ that lives in the intestines, is spread in feces, and can cause severe and dangerous diarrhea. In the United States, there are nearly 500,000 C. diff infections (CDI) reported each year.
This article discusses recovery from C. diff, issues that may arise after CDI is cured, dealing with a recurrence of CDI, and how to improve quality of life after CDI.
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Complications and quality of life after a C. diff infectionWhat Is C. Diff?
Anyone can get sick from C. diff bacteria. C. diff makes spores that are shed in feces and can live on surfaces for up to five months, even after cleaning with disinfectants. Once on your hands, the bacterium enters your body through your mouth and travels through your digestive tract to your intestines (fecal/oral route).
The most common symptoms of a C. diff infection are:
C. diff is easily spread from person to person. It can also be picked up by touching contaminated surfaces. It is a common hospital-acquired infection (HAI). Being in a healthcare facility like a hospital or nursing home raises your risk of a C. diff infection.
Risk Factors
The major risk factors for developing C. diff infection are:
Taking antibiotics
Having a weakened immune system (cancer treatment, human immunodeficiency virus, some medications)
Being older (age above 65)
Residing in a community-living environment, like nursing homes
Having had a previous C. difficile infection
Having inflammatory bowel disease (IBD)
Having had surgery involving the intestines
Life After C. Diff
Most of the time, people will develop C. diff symptoms after taking antibiotics for a different infection. Antibiotics, which are medications to kill infectious bacteria, also sometimes kill the normal, healthy gut bacteria. The environment in the intestines gets out of balance and “bad” bacteria like C. diff are able to increase.
Takeaway
Treatment for C. diff is generally effective. Most people get better in about two weeks, but some do have a recurrence of the infection after getting better. For some people, physical, emotional, and financial problems can linger even after C. diff infection is resolved.
Your experience will be unique, but your medical team can help you to navigate through recovery and to deal with any long-term issues related to your illness.
Physical Issues
Be sure to notify your healthcare provider of any diarrhea that you experience, especially after taking antibiotics. Early identification of C. diff infection is important so that you can start treatment. Unfortunately, getting sick with C. diff often results in a longer hospital stay to treat the new infection.
The C. diff bacteria can produce toxins that irritate the digestive system and cause diarrhea. Some people have up to 15 episodes of diarrhea each day. The frequent watery diarrhea can lead to dehydration and even kidney damage.
Preventing dehydration and replacing lost electrolytes are important parts of CDI management. Some people find that altering their diet can help with some of the diarrhea symptoms of CDI.
The C. diff toxins can irritate the lower part of the intestines (a condition called colitis). The colon then swells and becomes inflamed. If this gets bad enough, the intestines can rupture. In those cases, the damaged intestines need to be removed in surgery and can leave scars and longer-term gut problems.
In rare cases, the bacteria can spread to the blood (bacteremia) and cause sepsis. This is life-threatening and requires immediate medical attention. The Centers for Disease Control and Prevention (CDC) reports that nearly 13,000 people died of CDI in 2017.
Even after recovery from CDI, some people continue to experience physical problems. One study that looked into physical impacts in people who had a previous or active CDI found that people still had problems with sleep, their social life, with depression, and their ability to work. The longer people were sick with CDI, the more changes they reported to their quality of life.
Emotional Issues
Although it has not been heavily studied, some researchers have explored the emotional issues that follow C. diff infections.
After CDI, some people experience anger. They express anger about developing an infection as the result of medical treatment for another condition. Others are angry that they were exposed to this infection in a healthcare setting.
CDI is also associated with feelings of loneliness. Feelings of being involuntarily separated from others can be worsened by the isolation precautions many hospitals use to reduce the risk of transmission between patients or between patients and family.
Some people elect to avoid going out in public or eating at restaurants while recovering from CDI. The lack of participation in previous social activities can lead to further isolation.
Fears about C. diff infections returning are very common, as well. According to one study, most people report a fear of recurrence. In fact, 97% of those whose infection cleared and 99% of those who were currently infected reported a fear of the CDI coming back. Some people also report a fear of infecting others.
Taking antibiotics in the future can cause C. diff infection to return. People who have had previous CDI express fears that a relapse will be triggered by antibiotics they will need in the future.
Financial Burden
C. diff infections are a burden on the U.S. healthcare system as a whole and they are expensive for individual patients due to prolonged care. It's estimated that C. diff infections cost $6.3 billion per year in the United States. The average case of CDI acquired in the community costs just over $21,000, and the cost is much higher for cases acquired in a hospital.
There are several different reasons that CDI causes such significant medical expenses. Overall, people with CDI stay longer in the hospital, they are more likely to be treated in the intensive care unit (ICU), and they often need to be readmitted to the hospital.
If the C. diff recurs, there are additional expenses related to provider visits, lab tests, and medications for treatment. These may add unexpected costs even after your hospital stay.
In one research study, more than half of those with current or past CDI missed work. The lack of income while not working adds further to the financial burden of CDI.
Recurrence
The CDC reports that around 16% of people (about one in six) who have a C. diff infection will experience a repeat infection within two months. The recurrence (return of infection) can be a return of the original C. diff germs, or a person can be exposed to different C. diff germs. People with weakened immune systems are particularly at risk for getting sick from exposure to the C. diff bacterium, even if they have already recovered from a previous infection.
There are several risk factors for recurrent CDI, including:
Increased age (older adults are at higher risk)
Being admitted to the hospital in an emergency situation
Admission for stomach/intestine issues
Prior dialysis (treatment that takes over some kidney functions)
Prior chemotherapy (medication to treat cancer)
Preventing reexposure to the C. diff bacterial spores is important to lower the risk of recurrence. At home, handwashing and showering with soap and water are the best ways to make sure you are not carrying the C. diff germs on your body.
Takeaway
Unfortunately, hand sanitizers do not effectively kill the C. diff bacteria, so washing with soap and water is the best way to prevent spreading this germ.
The CDC recommends using a weakened bleach solution (one part bleach and nine parts water) to disinfect household surfaces. Clothing, bedding, and other laundry items should be washed before being used by other members of the household.
In the future, if you have an infection that requires antibiotics for treatment, be sure to share your C. diff history with your healthcare team. Your provider may make adjustments to the medications you are prescribed. Most importantly, avoid taking unnecessary antibiotics after recovering from C. diff.
Improving Quality of Life
Having infectious diarrhea from C. diff can have a profound effect on your quality of life. Researchers have identified that a CDI episode can have negative impacts on mobility, self-care, and participation in activities. CDI can also increase pain, anxiety, and depression. Higher levels of C. diff recurrence lead to physical and psychological quality-of-life issues.
The impacts of CDI last long beyond the actual infection for some patients. Depending on your recovery, improving your quality of life after CDI can require assistance. Work with your healthcare team to optimize your medications, participate in rehabilitation to regain strength, and take the time you need to rest and recover.
Summary
Clostridiodes difficile (C. diff) has effective treatments and is potentially curable. However, recurrence is common, and for some people, their symptoms may linger even after the infection is gone. When recovering from CDI, you may encounter additional health problems. Researchers continue to work on treatments to manage and treat C. difficile.
Frequently Asked Questions
How long does it take for C. diff to go away?
Typically, C. diff infections are treated for 10–14 days with an oral antibiotic. Once diarrhea resolves, it is usually safe to return to your normal activities as long as you are feeling well.
Will you ever fully recover from C. diff?
Most people recover from C. diff infection during the first course of treatment, while others may require additional medical interventions. Generally, the long-term effects of C. diff infection can be managed with support from your medical team.
Read the original article on Verywell Health.
