the bacteria Clostridioides difficile, which was formerly called Clostridium difficile and is now commonly known as C. difficult or just C. difference, is a common microorganism found in the environment. In general, it does not raise serious concerns for healthy individuals. However, some individuals who take antibiotics, especially for long periods of time, experience disturbances in their normal balanced gut flora (microbiota) as a result of the antibiotics inadvertently killing protective bacteria. This disruption can impair important immunoregulatory and metabolic functions, turning a relatively undetected organism into a harmful pathogen, raising serious health care concerns. Epidemiological estimates indicate that: C. difference causes about 500,000 infections per year in the United States, of which about 29,300 result in death. Given C. difference‘s continued status as a leading cause of healthcare-associated infections (HAIs), the month of November is appropriate C. difference Awareness Month by the Centers for Disease Control and Prevention (CDC).
Although antibiotic treatment is often the most common predisposition to a C. difference infection (CDI), other risk factors exist. For example, any of the following can lead to an increased risk of infection: being 65 years of age or older, having been recently hospitalized, or having a compromised immune system. In these cases C. difference can become an opportunistic pathogen, multiplying rapidly in the gut and producing toxins that cause intestinal disorders, such as diarrhea or colitis. In about 3% of healthy adults and 14-71% of healthy babies C. difference can colonize the gut as part of the normal gut microbiota, but will not produce toxins and therefore cause no symptoms.1 But these individuals, who are carriers, are also at a higher risk of developing an infection. Once a patient has active CDI, a course of antibiotics is the standard course of treatment, but this in turn further disrupts the gut microbiota resulting in a vicious cycle of recurrent CDI leading to reinfection within about 1-2 months for about 1 in of 6 patients.
C. difference produces spores that are highly resistant to desiccation (drying), heat and many disinfectants. This allows the spores to persist on surfaces for long periods of time and then potentially be transferred to hands, where they can be spread to other surfaces or patients. Community-related CDI is a serious concern, but healthcare-related CDI may pose a more pressing threat due to the transmission of other pathogens, in addition to C. difference, from the hands of healthcare workers to patients.
While guidelines for the management of CDI have been in place for many years, particularly in healthcare facilities, C. difference continues to spread. Recommended preventive measures include frequent hand hygiene with soap and water or hand sanitizers, use of personal protective equipment, cleaning and disinfection of surfaces with effective sporicidal products, and antibiotic administration programs. The persistence of CDI transmission in healthcare settings has been attributed in part to low adherence to recommended guidelines and to the lack of an effective approved sporicidal hand hygiene product. Alcohol-based hand gels (ABHRs), also known as hand sanitizers, although recommended for routine use in personal and healthcare settings because of their strong antimicrobial effects against many bacteria, fungi and viruses, they exhibit only limited antimicrobial properties against bacterial spores. Published evidence suggests that modifications of ABHRs, such as acidification to pH 1.2, can cause reductions of about 1.5 log10 (or about 97%) after use of the ABHRs, a reduction comparable to some hand washing with soap and water has delivered.2 As of the 2017 update of IDSA guidelines for medical management of CDI, ABHR use for hand hygiene after caring for a patient with C. difference is considered acceptable in routine and endemic settings. This is due to the benefits of greater adherence to treatment compared to hand washing with soap and water and the overall efficacy in reducing other common causes of HAIs.3 Thus, an incremental improvement in the sporicidal efficacy of ABHR, improved compliance with control measures and innovation of new technologies for sporicidal hand antiseptics would be beneficial in further reducing HAIs.
It is also worth noting that current and new research involving probiotic treatments, microbiome-based therapies, therapies to reduce the effects of C. difference toxins, and even dogs training odor detection to identify surfaces contaminated with C. difference are also evaluated.
At BioScience Laboratories, a Nelson Labs company, we have extensive experience growing multiple strains: C. difference, designing clinical trials to evaluate the efficacy of hand sanitizers and handwashing products, and evaluating EPA hard surface disinfectants. We are happy to support C. difference Awareness Month through our reviews of the products commonly used for the prevention of C. diff.
- Khalaf, N., Cres, J., DuPont, HL, and Koo, HL Clostridium difficile: an emerging pathogen in children. Discover Med. 2012 Aug: 14(75): 105-113. PMID: 22935207.
- Nerandzic, MM, Sunkesula, VCK, C., TS, Setlow, P., and Donskey, CJ (2015). Unlocking the sporicidal activity of ethanol: induced sporicidal activity of ethanol against Clostridium difficile and Bacillus spores under altered physical and chemical conditions. PLOS One, 10(7): e0132805. doi: 10.1371/journal.pone.0132805.
- McDonald, LC, Gerding, DN, Johnson, S., Bakken, JS, Carroll, KC, Coffin, SE, Dubberke, ER, Garey, KW, Gould, CV, Kelly, C., Loo, V., Sammons, JS , Sandora, TJ and Wilcox, MH (2018). Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical infectious diseases, 66(7): e1-e48. doi: 10.1093/cid/cix1085.