Is colonization with Clostridioides difficile (C. diff) harmful?

From the Guidelines

Colonization with C. difficile is not inherently bad, but it can increase the risk of developing C. diff infection, especially in individuals with compromised immune systems or those taking antibiotics that disrupt normal gut flora. Colonization means the bacteria is present in the gut without causing symptoms or disease, and about 3-5% of healthy adults are colonized with C. diff without any problems 1. However, colonization can become concerning in certain situations, such as when the person takes antibiotics, undergoes chemotherapy, or experiences other immune system challenges.

Key Points to Consider

• Colonized individuals can potentially transmit C. diff to vulnerable populations in healthcare settings 1.
• Unlike active C. diff infection, which causes diarrhea, abdominal pain, and fever and requires treatment with antibiotics like vancomycin or fidaxomicin, colonization alone typically doesn't require treatment.
• The distinction is important because unnecessary antibiotic treatment for mere colonization could actually increase the risk of developing symptomatic infection by further disrupting gut flora.
• Healthcare workers colonized with C. diff should practice good hand hygiene to prevent transmission to patients.
• Advanced age, duration of hospitalization, and exposure to antibiotic agents are also important risk factors for CDI 1.

Implications for Practice

• Healthcare workers should prioritize good hand hygiene to prevent transmission of C. diff to patients.
• Patients with compromised immune systems or those taking antibiotics should be closely monitored for signs of C. diff infection.
• Unnecessary antibiotic treatment for colonization should be avoided to prevent further disruption of gut flora.
• Further research is needed to understand the role of asymptomatic colonization in the transmission of C. diff and to develop effective strategies for preventing and managing CDI.

From the Research

Colonization with C. difficile

• Colonization with C. difficile is common, with a pooled prevalence of 8.1% 2.
• Asymptomatic colonization with C. difficile is much more common than symptomatic CDI and has been documented to contribute to new cases of CDI 3.
• Patients colonized with C. difficile upon hospital admission have a 5.9 times higher risk of subsequent CDIs compared with noncolonized patients 2.

Risk of Infection

• The risk of CDI for colonized patients is 21.8%, which is significantly higher than that of noncolonized patients (3.4%) 2.
• History of hospitalization during the previous 3 months is associated with a higher risk of colonization 2.
• Antibiotic therapy causes alterations of the intestinal microbial composition, enabling C. difficile colonization and consecutive toxin production leading to disruption of the colonic epithelial cells 4.

Treatment and Prevention

• Enhanced cleaning, avoidance of unnecessary antimicrobials, and use of gowns and gloves for patients with CDI are the cornerstone of C. difficile management in patients with known disease 3.
• New therapies have emerged in recent years, such as antibodies against C. difficile toxin B and fecal microbial transfer (FMT) 4.
• Oral vancomycin is proposed as the first choice for antibiotic treatment of CDI, with fidaxomicin as a good alternative, especially in patients at risk of relapse 5.
• Fidaxomicin has been shown to be associated with a significantly lower rate of recurrence of C. difficile infection compared with vancomycin 6.