Antibiotics, if used improperly, can cause diarrhea due to dysbiosis of the intestinal flora, and Clostridium difficile infection is one of them. Clostridium difficile, also known as Clostridium difficile, causes disease associated with the use of antibiotics, hence the term antibiotic colitis. Enteritis due to C. difficile is also the most common cause of acquired diarrhea in hospitalized patients.
Recognizing Clostridium difficile Clostridium difficile is an anaerobic bacterium. Anaerobic bacteria are those that grow better in anaerobic conditions than in an aerobic environment, and the human intestine happens to be a relatively anaerobic environment. Clostridium difficile is a member of the genus Clostridium. There are many members of the genus Clostridium, which can be divided into several groups, and several of them are pathogenic to humans. The best known are Clostridium perfringens, Clostridium tetani and Clostridium botulinum. Clostridium perfringens can cause gas gangrene of wounds, food poisoning, muscle necrosis, clostridial cellulitis, etc. Clostridium tetani can cause tetanus, and Clostridium botulinum can cause botulism. The typical clinical feature of botulism is acute flaccid paralysis, starting with bilateral cranial nerve obstruction, including the muscles of the face, skull, and pharynx, followed by symmetrical descent, including the muscles of the larynx and limbs. Respiratory distress that can be caused by paralysis of the tongue or pharyngeal muscles, and paralysis of the septum and ribs may cause death. Clostridium perfringens is a common bacterium that causes food poisoning.
How this bacterium causes disease C. difficile is able to cause disease because it has three virulence factors: toxin A, toxin B, and a substance that inhibits intestinal motility. Toxin A is enterotoxic and toxin B is cytotoxic. Toxin A also has some cytotoxic effect, but it is less than toxin B. Toxins A and B are the main pathogenic factors of C. difficile and interfere with the actin backbone of intestinal epithelial cells, disabling the cells. C. difficile is widely distributed in natural habitats such as soil, hay, sand, the feces of some large animals (cattle, donkeys and horses), and the feces of dogs, cats, rodents and humans. C. difficile is often found in the feces of infants, with approximately 50% of 12-month-old infants having C. difficile in their intestines and approximately 3% of children over 2 years of age, but it is less frequently found in healthy adults, with 1.9% of asymptomatic adults in Sweden and 15.4% in Japan.
C. difficile infection and antibiotics C. difficile often infects hospitalized patients and colonizes the body. One study found that 399 patients were admitted with undetectable C. difficile and 21% developed C. difficile diarrhea during their hospitalization. All antibiotics and some chemotherapeutic agents were associated with C. difficile-induced diarrhea or pseudomembranous colitis, most commonly ampicillin, clindamycin, and cephalosporins. It is evident that improper antibiotic use is closely associated with C. difficile diarrhea and is the most common cause of intestinal infections in hospitalized patients.
How to diagnose C. difficile diarrhea There are several laboratory tests that can help diagnose C. difficile-associated diarrhea (CDAD). Toxin assays and toxin neutralization tests on cultured cells are often considered the “gold standard”. Toxin-producing cultures are used to detect toxin production in C. difficile isolates and have a high sensitivity and considerable specificity. In contrast, direct stool specimen toxin neutralization tests will fail to detect toxin in 15-38% of patients with confirmed CDAD. Some patients who test negative for cytotoxin in direct stool specimens may develop pseudomembranous enterocolitis. If not treated properly, a proportion of patients can die.
The key to preventing C. difficile diarrhea is to use antibiotics appropriately, but not for long periods of time and in large doses. Most strains of C. difficile are sensitive to many antibiotics in vitro, including penicillin, tetracycline, and quinolones. However, enteric disease caused by this bacterium is still usually treated with oral vancomycin or methotrexate. Enteral administration may be used for patients who cannot tolerate oral antibiotic therapy.