Risk Assessment After Two C. difficile Infections with Two Years of Recovery
After experiencing two C. difficile infections (including a recurrence after stopping vancomycin), you are considered at low risk for another recurrence after being symptom-free for two years.
Understanding Your Risk Status
The risk of recurrence after C. difficile infection (CDI) is highest within the first 8 weeks after completing treatment. According to the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) guidelines, approximately 25% of patients treated for CDI with vancomycin can experience at least one additional episode 1. However, this risk diminishes significantly over time.
Key factors that influence your current risk:
- Time since last infection: Being symptom-free for two years is highly significant and indicates successful resolution
- Number of previous episodes: Having had two episodes (initial infection plus one recurrence) does increase lifetime risk compared to having just one episode
- Treatment received: The fact that you received vancomycin for treatment is appropriate
Current Risk Assessment
Your two-year recovery period without symptoms indicates that:
- Your gut microbiome has likely recovered from the disruption caused by C. difficile and its treatment
- The risk of spontaneous recurrence at this point is similar to the general population risk of new infection
- You are no longer in the high-risk window (first 8 weeks post-treatment) when most recurrences occur
Future Considerations
While your current risk is low, you should be aware of situations that could increase your risk:
- Antibiotic exposure: Any future antibiotic treatment represents the highest risk factor for CDI recurrence
- Healthcare facility exposure: Hospitalization increases exposure risk
- Age: If you're over 65, continued vigilance is warranted as age is a risk factor
Recommendations for Future Care
If you need antibiotics in the future:
- Inform all healthcare providers about your history of recurrent C. difficile infection
- Consider prophylaxis: If you require systemic antibiotics in the future, some evidence suggests prophylactic oral vancomycin (125 mg twice daily) during and after antibiotic treatment may be beneficial for high-risk patients 2
- Monitor for symptoms: Be alert for changes in bowel habits, particularly diarrhea, during and within 8 weeks after antibiotic treatment
When to Seek Medical Attention
Seek prompt medical evaluation if you develop:
- Diarrhea (≥3 loose stools in 24 hours)
- Abdominal pain or cramping
- Fever
- Blood in stool
Bottom Line
Having been symptom-free for two years after your recurrent infection is an excellent prognostic sign. Your risk of another C. difficile infection is now primarily dependent on future exposures to antibiotics and healthcare settings rather than your past infection history.