What causes Clostridioides difficile (C. diff) infection?

From the Guidelines

Clostridioides difficile (C. diff) infection is primarily caused by the disruption of normal gut bacteria, typically following antibiotic use, with antibiotics like clindamycin, fluoroquinolones, cephalosporins, and penicillins being most commonly associated with C. diff infections. The use of these antibiotics can kill beneficial gut bacteria that normally keep C. diff in check, allowing C. diff to multiply rapidly and produce toxins that damage the intestinal lining 1. Other risk factors for C. diff infection include advanced age (over 65), hospitalization or residence in healthcare facilities, weakened immune systems, previous C. diff infections, and gastrointestinal surgeries or conditions 1. The bacterium spreads through fecal-oral transmission, with spores that can survive on surfaces for months, and healthcare settings are common transmission sites, as the spores can be carried on hands, medical equipment, or contaminated surfaces 1.

Some key points to consider in the prevention and management of C. diff infection include:

• The importance of judicious antibiotic use to minimize the risk of disrupting normal gut bacteria 1
• The need for prompt and accurate diagnosis of C. diff infection to initiate appropriate treatment and prevent transmission 1
• The use of contact precautions, such as gloves and gowns, to prevent the spread of C. diff spores in healthcare settings 1
• The importance of environmental cleaning and disinfection, particularly in areas where C. diff spores are likely to be present 1

It is also important to note that while proton pump inhibitors (PPIs) have been associated with an increased risk of C. diff infection, the evidence for this association is not strong, and further study is needed to fully understand the relationship between PPI use and C. diff risk 1.

Overall, the prevention and management of C. diff infection require a multifaceted approach that includes judicious antibiotic use, prompt diagnosis and treatment, and careful attention to infection control and environmental cleaning practices.

From the Research

Causes of C. diff Infection

The causes of Clostridioides difficile (C. diff) infection are not explicitly stated in the provided studies. However, the following factors are mentioned as contributing to the development of C. diff infection:

• Use of antibiotics, which can disrupt the gut microbiome and lead to dysbiosis 2, 3
• Hospitalization and exposure to healthcare settings, where C. diff spores are commonly found 4, 5
• Advanced age and presence of comorbidities, which can increase the risk of C. diff infection 4, 2
• Previous C. diff infection, which can increase the risk of recurrence 6, 3

Risk Factors for C. diff Infection

The following risk factors are mentioned in the studies:

• Antimicrobial agents, which can disrupt the gut microbiome and lead to dysbiosis 3
• Non–North American Pulsed Field type 1 strains, which are associated with a higher risk of recurrence 6
• Severe or fulminant C. diff infection, which is associated with high mortality rates 4, 5

Transmission of C. diff

The studies mention the following ways in which C. diff can be transmitted:

• Through fecal microbiota transplantation (FMT), which can transmit pathobionts like extended-spectrum beta-lactamase Escherichia coli and Shiga toxin-producing E. coli 2
• Potentially through FMT during the COVID-19 pandemic, which could transmit SARS-CoV-2 2