Recurrence rates of C. diff are high. The likelihood of having another recurrence episode rises dramatically after you've had one.
One bacterium that can induce diarrhoea and colon inflammation is C. diff. It is common for C. diff to recur.
Your chance of experiencing more recurrence episodes rises once you've experienced one.
Find out more about the causes, prevalence, risk factors, symptoms, and preventative measures of C. diff recurrence.
What is C. diff recurrence?
C. diff, sometimes known as Clostridium difficile or C. difficile, is a kind of bacteria that inflames your colon and results in diarrhoea.
Antibiotics can alter the bacteria in your colon, which can promote the growth of C. diff.
A C. diff infection that recurs is known as a recurrent infection. If a C. diff bout occurs within 8 weeks of an earlier infection, it is usually regarded as recurrent.
How common is a recurrence of C. diff?
C. diff is prone to recurrence.
After a previous episode of C. diff infection, about 1 in 6 persons will get another one in two to eight weeks.
The likelihood of a subsequent recurrence rises after the first one has healed. About 40% of people, according to a 2019 scientific review, will go through a second recurrence after their initial one has healed.
According to the same analysis, those who have experienced more than two C. diff recurrences have a 45–65% recurrence rate.
Why does C. diff recurrence happen?
Both the quantity and severity of C. diff cases have significantly increased in the United States, Canada, and other nations since 2000.
According to a prior analysis of the literature, cases of C. diff were more common, damaging, less responsive to therapy, and more likely to recur between 2003 and 2006.
The advent of NAP1/BI/027, a particularly virulent strain of C. diff, may be partly to blame for these increases.
Recurrence rates against C. diff are probably also influenced by rising drug resistance.
Antibiotic resistance issues may be the cause of the higher recurrence rate following a prior recurrence. The issue may get worse if an antibiotic is used to treat a sickness that is brought on by antibiotics. This might occur as a result of the good bacteria in the colon not having an opportunity to proliferate.
Who is at risk of a recurrence of C. diff?
A recurrence of C. diff is more likely due to several possible risk factors.
Advanced age
One of the most often mentioned risk factors for recurrent C. diff infection is older age.
According to a 2005 study, the probability of a C. diff recurrence in the years 2003–2004 was 25% for those aged 0–17, 27.1% for those aged 18–64, and 58.4% for those aged 65 and beyond. Compared to previous years, these figures showed a notable rise in likelihood.
Although the exact cause of an older person's higher recurrence rate than that of a younger person is unknown, it is thought to be related to a decline in immune response and an increase in other medical disorders.
Antibiotic use
One of the most important modifiable risk factors for recurrent C. diff infection is the use of antibiotics. This indicates that it's a modifiable risk factor as opposed to age.
C. diff infections are seven to ten times more common in the month following antibiotic therapy and when taking antibiotics.
The microbiome in your intestines is altered by antibiotics, which facilitates the growth of C. diff. Antibiotics alter the makeup of bile acids in your colon, which can encourage the growth of C. diff bacteria by altering your gut flora.
Previous antibiotic use has been linked to an increased risk of recurrent C. diff infection, according to studies.
Hypervirulent strains
The NAP1/BI/027 strain of C. diff has been associated with higher recurrence rates in those who have contracted it.
Compared to other strains, this particular strain of C. diff produces more toxins. It also creates a particular class of toxins that support the growth and survival of the C. diff bacteria in your digestive system.
Furthermore, this strain has high resistance to the fluoroquinolone class of medicines.
A 2012 clinical research with 719 C. diff patients showed that the NAP1/BI/027 strain carried a 27.4% recurrence risk. In contrast, 16.6% of patients with other strains experienced recurrences.
Gastric acid suppression
Acid-suppressive medications are frequently used to avoid ulcers and other acid-related health issues. However, the absence of acidity in your stomach may make you more susceptible to catching C. diff.
Recurrent C. diff is more likely in those who have used stomach acid suppressants than in those who have not, per a 2017 research review.
Other risk factors
Many risk factors for the recurrence of C. diff infection have been documented, such as:
- a prolonged hospital stay
- decreased kidney function
- severe underlying disease
- a recent nursing home stay
- a compromised immune system (caused by immunosuppressive drugs, HIV, cancer, or other conditions)
Symptoms of C. diff recurrence
If C. diff recurs, you might notice a return of your earlier symptoms.
Among the symptoms could be:
- abdominal pain
- soreness in your abdomen
- diarrhea
- lack of appetite
- fever
- nausea
How to reduce the risk of C. diff recurrence
The Centres for Disease Control and Prevention (CDC) state that skipping needless antibiotic use is the greatest strategy to keep C. diff from resurfacing.
It's crucial to disclose any prior C. diff infections to medical personnel when corresponding with them. If they are required to prescribe antibiotics, this will enable them to make the best choices for you. Additionally, you want to disclose to your dentist any past infections you may have had.
C. diff germs can spread from person to person. When someone uses the loo, they should always wash their hands well using soap and water to prevent the spread of bacteria to other persons or items.
It's crucial to wash your hands correctly with soap and water before eating and after using the loo.
What happens if C. diff keeps coming back?
In certain individuals, C. diff may recur repeatedly. In such cases, a physician might suggest other therapies.
For instance, they might suggest doing an antibiotic course with the medication bezlotuxumab, which is administered intravenously.
A faecal microbiota transplant is one of the best treatments for recurrent C. diff (FMT). The patient undergoing this treatment will have stool from a healthy donor inserted into their colon to treat recurrent C. diff. This usually occurs in the course of a colonoscopy.
Studies show that 90% of patients who receive FMT find it to be successful, according to the American College of Gastroenterology.
There are currently new, less invasive types of FMT accessible. Rebyota is a type of enema that can be given at a doctor's office. Additionally, Vowst faecal microbiota pills are available for oral use. The FDA has authorised both. Faecal transplants are now far more accessible because of these techniques.
The takeaway
The frequency of C. diff recurrence is high. Your chances of having a recurrence rise once you've had one.
Recurrence of C. diff may be more likely in cases when risk factors such as compromised immune system, antibiotic use, stomach acid suppression, and advanced age are present.
C. diff is less likely to recur if you avoid using antibiotics when they are not needed and constantly wash your hands well.
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