C. difficile Infection – Diagnosis and Treatment

Diagnosis

Checking Stool Samples

Doctors look for clostridium difficile in stool to confirm a C. difficile infection. Lab staff use nucleic acid amplification test (NAAT) or enzyme immunoassay (EIA) to identify the bacteria or its toxins.

These tests help doctors find out if the infection causes symptoms like watery diarrhea or abdominal pain. Patients who have regular, formed stools do not need this test.

Test Type What It Detects Usefulness
Nucleic acid amplification (NAAT) Bacterial genetic material High accuracy in detecting infection
Enzyme immunoassay (EIA) C. difficile toxins Fast results, sometimes needs confirmation

Direct View of the Colon

A colon exam, such as flexible sigmoidoscopy or colonoscopy, can help if the diagnosis is unclear. These tests let doctors see signs of colitis or pseudomembranous colitis by looking directly at the colon’s lining.

Doctors use a thin, flexible tube with a camera to spot signs of inflammation or other problems. Most patients do not need this kind of exam.

Scans and Imaging for Complications

Doctors use imaging tests, like an abdominal X-ray or CT (computed tomography) scan, to find serious complications from clostridium difficile infection.

These scans can show if the colon wall is swollen, if the bowel is enlarged, or if there is a hole (perforation) in the colon. Doctors order these tests mainly if they suspect problems beyond a mild infection.

Treatment

Medications to Fight the Infection

Doctors use specific medicines as the main way to handle this infection. If antibiotics caused the infection, doctors may stop the current antibiotic.

Sometimes, doctors prescribe a different antibiotic for another illness and try to pick one that is less likely to upset the gut bacteria.

The most common medicines are:

Medication Name Notes
Oral Glycopeptide Antibiotics Often used as a first-line treatment for C. difficile infection.
Narrow-Spectrum Macrolide-Like Antibiotics Specifically targets C. difficile bacteria.
Nitroimidazole Antibiotics May be used in combination therapy for more severe cases.

These medicines stop the growth of harmful bacteria. Doctors may switch antibiotics to safer ones if the patient still needs them for other problems.

Doctors may hospitalize patients if symptoms are very severe or if a person cannot keep fluids down.

Doctors do not usually recommend antiperistaltic agents (medicines to slow down or stop diarrhea), since these can keep toxins in the gut longer and might make things worse.

Surgery as an Option for Severe Cases

In rare, serious cases when medicine does not work, doctors may need to do surgery. Surgery is mostly for those who have very bad pain, organ failure, toxic megacolon, or a severely inflamed and swollen colon.

Doctors may remove the damaged section of the large intestine (colon) to prevent life-threatening problems. Surgery is not the first choice, but doctors consider it when other treatments do not work.

Methods for Judging and Handling Repeated Illness

Repeat infections can be difficult to manage. About one-fourth of people treated for this infection may have symptoms again.

After three infections, the chance of another infection can increase to over 50%. Older adults, people who need more antibiotics, or those with chronic health conditions have a higher risk.

Ways to address repeated illness include:

1. Different Antibiotics

If the infection returns, doctors may start a new round of antibiotics. They can try a different antibiotic, as the same one may not work as well the second time.

2. Antibody Therapy

Doctors may use a monoclonal antibody therapy that targets the toxin produced by the C. difficile bacterium. This treatment is typically recommended for patients at high risk of recurrence and can help reduce the chance of future infections.

3. Stool Transplant (FMT)

Doctors may use fecal microbiota transplant (FMT), also called a stool transplant, to treat repeat infections. This method adds healthy bacteria from a screened donor’s stool to the patient’s colon.

Doctors carefully check donors’ blood and stool to avoid dangerous germs. FMT is not officially approved by medicine agencies but is allowed as a study treatment for repeated C. difficile infection.

Doctors often use special tubes placed into the rectum to deliver the transplant. FMT has a success rate of more than 85% for persistent cases after other treatments fail.

Patients may need to give special consent, since the treatment still has risks that are being studied.

4. Probiotics

Probiotics are products or supplements that try to add good bacteria to the gut. Right now, it is not clear how much they help with this infection.

Some studies show little or no clear benefit. For this reason, doctors mostly use probiotics in research settings and not as a standard treatment.

Daily Habits and At-Home Care

Drink plenty of fluids that contain water, salt, and sugar when you have diarrhea. Good options include diluted fruit juice, soft drinks, broths, and water with a pinch of salt and sugar.

Eat bland starchy foods like potatoes, noodles, rice, wheat, and oatmeal. Saltine crackers, bananas, boiled vegetables, and soup are also gentle on the stomach.

After your symptoms get better, you might have trouble digesting dairy for a short time.

Tip: Try including probiotics like yogurt with live cultures to support gut health.


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