Mrs. G was admitted from the ER to our ICU in shock. This quite healthy 80 year old woman had an infected toe about a month prior to admission. It responded to antibiotics and initially she did well. But when I first saw her she was on death’s door: blood pressure 70/20; pulse 130; no urine output; unconscious; and a very distended abdomen with no bowel sounds.
Her initial “antibiotic associated diarrhea” had seemed to taper off but not completely go away. Then it accelerated and there was delay in seeking medical attention and she was “crashing.” The CT scan showed hugely dilated loops of colon and a limited scoping of the colon showed angry looking “pseudomembranes” – all compatible with life threatening Clostridium Difficle colitis.
The C. Diff. toxin proved to be positive, but in the meantime attempts were made to get two drugs into her bowel lumen to fight the infection. But there wasn’t time to wait. At midnight, she was taken to the OR for a complete colon removal and colostomy. Within hours she rallied and was out of the hospital within a week – but with a drastic change in her daily life.
Note: Most C diff infections resolve on their own as the normal gut bacteria reestablishes and no treatment is necessary. Some believe that probiotics and/or yogurt help but that’s unproven. For symptomatic patients there are several anti-microbials which are useful (see CDC info). Hand washing (soap & water) for personnel and dilute bleach as a disinfectant are standard recommendations in prevention. Patients need to be aware that C diff can recur and that they need to follow closely with their physicians. Needless to say, often antibiotics are over-prescribed for “the flu” and other viral infections – so trying to avoid antibiotics unless truly necessary is wise. The “Difficle” name was attached to the organism because it was difficult to stain and grow. But as noted, it’s difficult in more ways than one.