CausesBy Mayo Clinic staff
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|Colon and rectum|
C. difficile bacteria can be found throughout the environment — in soil, air, water, and human and animal feces. A small number of healthy people naturally carry the bacteria in their large intestine. But C. difficile is most common in hospitals and other health care facilities, where a much higher percentage of people carry the bacteria.
C. difficile bacteria are passed in feces and spread to food, surfaces and objects when people who are infected don't wash their hands thoroughly. The bacteria produce hardy spores that can persist in a room for weeks or months. If you touch a surface contaminated with C. difficile, you may then unknowingly ingest the bacteria.
People in good health don't usually get sick from C. difficile. Your intestines contain millions of bacteria, many of which help protect your body from infection. But when you take an antibiotic to treat an infection, the drug can destroy some of the normal, helpful bacteria as well as the bacteria causing the illness. Without enough healthy bacteria, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, clindamycin and penicillins.
Once established, C. difficile can produce toxins that attack the lining of the intestine. The toxins destroy cells and produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon.
Emergence of new strain
An aggressive strain of C. difficile has emerged that produces far more toxins than other strains do. The new strain is more resistant to certain medications and has shown up in people who haven't been in the hospital or taken antibiotics. This strain of C. difficile has caused several outbreaks of illness since 2000.
- Kelly CP, et al. Treatment of antibiotic-associated diarrhea caused by Clostridium difficile in adults. http://www.uptodate.com/home/index.html. Accessed Sept. 28, 2010.
- Bartlett JG. Narrative review: The new epidemic of Clostridium difficile-associated enteric disease. Annals of Internal Medicine. 2006;145:758.
- Pepin J, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: A changing pattern of disease severity. Canadian Medical Association Journal. 2004;171:466.
- Kelly CP, et al. Clostridium difficile — More difficult than ever. New England Journal of Medicine. 2008;359:1932.
- LaMont JT. Clinical manifestations and diagnosis of Clostridium difficile infection in adults. http://www.uptodate.com/home/index.html. Accessed Sept. 28, 2010.
- Efron PA, et al. Clostridium difficile colitis. Surgical Clinics of North America. 2009;89:483.
- Monaghan T, et al. Recent advances in Clostridium difficile-associated disease. Gut. 2008;57:850.
- Kelly CP, et al. Antibiotic-associated diarrhea, pseudomembranous enterocolitis, and Clostridium difficile-associated diarrhea and colitis. In: Feldman M, et al. Sleisenger and Fordtan's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.mdconsult.com/books/linkTo?type=bookPage&isbn=978-1-4160-6189-2&eid=4-u1.0-B978-1-4160-6189-2..00108-6. Accessed Sept. 30, 2010.
- Bartlett JG, et al. Clinical recognition and diagnosis of Clostridium difficile infection. Clinical Infectious Diseases. 2008;46(suppl):S12.
- Bakken JS. Fecal bacteriotherapy for recurrent Clostridium difficile infection. Anaerobe. 2009;15:285.