C DIFF INFECTIONS: WHAT ARE THEY? WHY SO COMMON IN IBD?

You may have heard of C. diff, which is really an easy way to refer to the bacteria called Clostridium difficile. The C diff bacteria can release a toxin, which can cause intestinal damage. That damage can show up with:

• Diarrhea, sometimes with blood 
• Abdominal pain
• Bloating  
• Symptoms of a IBD flare

We all seem to have the bacteria in our intestines normally as part of our bacterial flora or microbiome. But we go on antibiotics for an infection, that can wipe out some of our healthier bacteria in intestine—and that can allow C diff to grow and develop into a serious infection. If someone goes into the hospital, and stays there for more than a few days, they are also more prone to getting C diff infections.

C diff in IBD

Normally, older patients (especially those over 65) are more prone to getting C diff infections, but those with IBD are likely to get C diff infections at much younger ages. Because C diff mainly lives in the large intestine, those with ulcerative colitis are about 3 times more likely to getting the infection than those with Crohn's disease. And it can occur even without being on antibiotics or in a hospital. 

There seem to be several reasons why those with IBD can get C diff infections more easily. They have damaged intestines where the C diff can thrive. They don't have a normal microbiome—those with IBD have fewer bacteria in their intestines and fewer types of bacteria and microbes, and that means that they aren't as able to fight off the infection. They also produce certain chemicals (primary bile salts) that actually promote the growth of C diff.

It's also concerning that those with IBD who then get C diff can have more problems. They may require more time in the hospital, increased treatment or surgery. That can depend on their general health and age and how they are treated.

Finding C diff Infections

Blood tests can't detect C diff infections. Specific stool tests must be done.

Preventing C diff

• Handwashing is the best protection, because soap and water remove and kill off the bacteria. Hand cleansers do not do nearly as well. 
• Cleaning surfaces well is important for those who have IBD or immune problems, because C diff can live on surfaces for months.
• Probiotics and prebiotics can allow beneficial bacteria to rebalance the intestine's microbiome, helping to overwhelm the c diff.  
• Certain medicines may need to be stopped temporarily if there is a high likelihood of getting a C diff infection.

Treating C diff Infections

Treatment can be done in several ways. This is particularly important to understand because C diff infections can return over 20% of the time.