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New treatment guidelines may reduce and deter the sometime serious impacts of infection with Clostridoides difficile (C. diff).

A bacterium that causes inflammation of the colon (colitis) and severe diarrhea, C. diff can be serious at any age.  It more often impacts patients on antibiotic treatment, those who are immune compromised, individuals who have had a recent care facility stay, or patients over 65 years of age. 

C. diff is common in healthcare settings like nursing facilities or hospitals.  As a healthcare-associated infection (HAI) it spreads in care facilities and is difficult to eradicate from hospital settings.  According to the Centers for Disease Control and Prevention (CDC), there are approximately 500,000 C. diff infections in the US each year.  Of those cases, one in six patients will suffer a recurrence of this virulent infection within the next month or two.  For patients over 65, mortality is high. One in 11 people diagnosed with HAI C. diff will die within the month.

The human microbiome is home to about 39 trillion different good, bad, and indifferent germs, including bacteria, fungi, and viruses that live on and in our bodies. By comparison, there are only about 30 trillion human cells, which points to the interesting fact that humans are valuable real estate to our microbial friends. C. diff is a resident in the normal human microbiome.

When humans suffer infection, treatment with antibiotics aims to tamp down the infectious microbe. In the process, treatment impacts the rest of the living microbiome as well. When “good” microbiota are suppressed, germs like C. diff are able to gain a foothold in individuals without an otherwise robust immune system. Symptoms of C. diff include severe diarrhea, pain, nausea, and fever. Because it causes the colon to become inflamed, the infection can lead to the development of sepsis with a potentially fatal outcome for the patient.

C. diff is commonly treated with antibiotics and is often drug-resistant as well.  Given the need to carefully and effectively treat C. diff, new guidelines were recently released that include three recommendations:

  • If available, the antibiotic fidaxomicin is suggested instead of vancomycin for C. diff infection.
  • For patients with recurrent C. diff infection, fidaxomicin is recommended. Fecal microbial transplant is recommended as a co-treatment.
  • The use of the human monoclonal antibody, bezlotuxumab, is recommended as a co-treatment with antibiotics for patients with recurrent C. diff.

C. diff infections can have serious consequences.  New guidelines may offer some hope in treating this dangerous infection.

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