Protect Yourself Against C. Diff Infections

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Antibiotics treat infections, but surprisingly, they can cause them, too. In fact, a new study finds that the number of virulent infections linked to the use of antibiotics has skyrocketed.

The study, published this month in the Annals of Internal Medicine, documents the alarming rise in recurring, hard-to-treat infections caused by the bacterium Clostridium difficile, or C. diff. What’s most worrisome: This deadly bacteria lurks where you’d least expect it to and where it can do a great deal of harm—in hospitals and other healthcare facilities.

After analyzing the medical records of more than 38 million patients, University of Pennsylvania researchers discovered that the incidence of  “multiply recurrent” C. diff (or mrCDI) infections increased by almost 200 percent between 2001 and 2012.

The rate of standard, more easily treated C. diff infections also increased—but by a slightly less eye-popping 40 percent.

C. diff bacteria attack the intestines, causing dangerous inflammation, abdominal cramping, and severe diarrhea. Each year in the U.S., C. diff sickens an estimated 500,000 Americans and contributes to the deaths of 29,000, according to the CDC.

The rise in recurring C. diff infections signals a need for healthcare facilities to be more vigilant about protecting patients, says the senior author of the study, James D. Lewis, M.D., professor of gastroenterology and senior scholar in the Center for Clinical Epidemiology and Biostatistics.

“It also indicates a demand for other treatments,” he says, pointing out that the standard antibiotic treatment used to treat the infection just isn’t working for many patients.

How and Where You Get C. Diff

Most people who develop a C. diff infection are taking an antibiotic, or took one in the previous few months. In addition to harmful bacteria, antibiotics also destroy those protective bacteria in the intestines for up to several months. That allows the dangerous C. diff bacteria an opportunity to take hold and multiply.

Half of hospitalized patients receive an antibiotic during their stay, according to the Centers for Disease Control and Prevention, leaving them particularly vulnerable to C. diff. And unless the hospital is scrupulous about hand-washing and disinfection, the bacteria can easily spread from one patient to the next via hospital staff or equipment.

Doctors typically treat infected patients with another antibiotic, one capable of killing C. diff bacteria. But this new study shows that once-reliable antibiotic treatments are no longer working in many cases. More patients have persistent or recurring diarrhea and other symptoms of C. diff for two months or longer, even after being treated with three or more courses of different antibiotics.

The Rise of Fierce Infections and New Treatments

One important contributor to the increase in intractable C. diff infections is likely the overuse of “specific antibiotics, namely fluoroquinolones,” says Clifford McDonald, M.D., associate director for science in the division of healthcare quality promotion at the CDC.

Fluoroquinolones, a category of antibiotics that includes commonly prescribed medications such as Cipro and Levaquin, are known as “broad-spectrum” antibiotics because they kill a wide variety of bacteria. Because those antibiotics kill more of your body’s “good” bacteria than more narrowly targeted drugs such as penicillin, they leave you more vulnerable to C. diff.

A recent study published in the medical journal The Lancet found that when hospitals in the U.K. cut back on prescribing fluoroquinolone antibiotics, the rate of C. diff infections dropped by a whopping 80 percent.

Another contributor to the increased infection rate is the “rise of more virulent strains of C. diff that have a higher recurrence rate,” McDonald says. Overuse of antibiotics also contributes to the development of “superbugs,” bacteria that are immune to multiple types of antibiotics.

Study author Lewis says that this latest research underscores the need to look beyond antibiotics for treating stubborn C. diff infections.

One promising treatment is a fecal microbiota transplant, a procedure in which a doctor places stool from a healthy donor into an infected person’s colon, usually using colonoscopy. The idea is to repopulate the colon with good bacteria to fight off C. diff.

Lewis points out that although the procedure appears to be relatively safe and effective in the short term, “the long-term safety has not been well-studied.”

Still, the Food and Drug Administration found the evidence compelling enough to allow doctors to perform the procedure in C. diff patients with diarrhea and other symptoms that persist after being treated with antibiotics.

Protect Yourself Against C. Diff

Some hospitals do a better job than others of stopping the spread of C. diff and other disease-causing germs, says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project.

“To find out if your hospital makes infection prevention a priority, ask the hospital if they have an antibiotic stewardship program, which helps ensure that drugs are used appropriately," says McGiffert. "And do your own due diligence and look at the hospital’s C. diff infections rates to see if they are significantly lower—or higher—than other hospitals."

“The problem is that it can be really hard for consumers to get that information,” she says. To see how hospitals in your community compare in their ability to prevent C. diff infections, check our Ratings.

Once you (or family members or friends) are in the hospital, here’s what you can do to reduce your risk of developing a C. diff infection:

• Make sure you really need that antibiotic. If your doctor wants to give you an antibiotic, ask why. Research from the CDC shows that half of antibiotics given in the hospital are not needed, or are the wrong type—a broad-spectrum drug, for example, instead of a more targeted one. If the doctor suspects an infection, he or she should do a rapid culture, if possible, to quickly pinpoint the possible bacteria and prescribe the most effective antibiotic at the lowest dose.

• Insist on hand-washing and gloves. Ask everyone who walks into your room whether they’ve washed their hands with soap—if they’re doing it at your sink, make sure they scrub for 40 to 60 seconds. And check that they are wearing gloves when needed. Rubbing on alcohol-based hand sanitizer is not strong enough to destroy C. diff, according to the CDC. “Also keep your own hands clean by washing regularly with soap and water,” advises McGiffert.

• Bring your own bleach wipes. C. diff and other bacteria can live for weeks on surfaces such as bedrails, doorknobs, and T.V. remotes. Clean anything you touch with a disinfectant wipe, McDonald says.

• Watch out for heartburn drugs. Hospital patients are sometimes prescribed heartburn drugs called proton-pump inhibitors, such as esomeprazole (Nexium and generic) and omeprazole (Prilosec and generic) to prevent heartburn or bleeding in the stomach. But those medications can also increase the risk of C. diff infections because they reduce the stomach acids that would typically kill C. diff bacteria. Instead, the bacteria continue unharmed into the lower intestine, where they thrive. So if your doctor suggests you take one of those drugs while in the hospital, ask why, McDonald suggests.

• Ask about the hospital’s protective measures. Hospitals should order a C. diff test for any patient who has diarrhea (three loose stools within 24 hours), the CDC says. Anyone with diagnosed C. diff should be put in a single room, and healthcare providers should wear gloves and gowns when treating that patient.

• Stay vigilant at home. You may continue to be vulnerable to a C. diff infection even after you check out of the hospital, so keep up the hand-washing and disinfection as you recover at home as well, McDonald advises. If you develop any signs of a possible infection—fever, diarrhea, abdominal pain, nausea, or loss of appetite—contact your doctor right away.

Editor's Note: This article and related materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

Clarificaton: An earlier version of this article attributed the highlighted research to the CDC. In fact, the study published July 4 in the Annals of Internal Medicine was supported by the National Institutes of Health and conducted by researchers at the University of Pennsylvania.

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