Clostridioides Difficile Infection

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KEY POINTS

• Clostridioides (Clostridium) difficile (C. diff) is bacteria that infects the bowel and causes severe diarrhea.
• Dehydration caused by diarrhea can be dangerous, especially for children. Your child needs to drink enough liquid to replace the fluids and minerals lost.
• Treatment may include antibiotic medicine, or in rare, severe cases, surgery.

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What is Clostridioides (Clostridium) difficile infection?

Clostridioides (Clostridium) difficile (C. diff) is bacteria that can cause diarrhea in children. A child can have these bacteria in the intestines without getting sick. However, if your child has too many, they can damage the large intestine (colon) and cause mild diarrhea or a serious, even life-threatening infection.

What is the cause?

Your child can get C. diff bacteria from the bowel movements of an infected person. The bacteria can pass from one person to another if someone has touched a surface that has C. diff on it and does not wash his or her hands. The bacteria can live for many hours on surfaces such as toys, toilet seats, door handles, and bathroom fixtures.

Your child may get a C. diff infection if your child has been taking antibiotic medicine to treat an infection caused by other bacteria. Taking antibiotic medicine can upset the natural balance of "good" and "bad" bacteria in the intestines. When an antibiotic medicine kills too many “good” bacteria, C. diff bacteria can grow in the intestines and cause an infection.

Your child has a higher risk of getting a C. diff infection if:

• Your child has recently been cared for in a hospital or long-term care facility.
• Your child has a medical condition that lowers the ability to fight infections such as diabetes or cancer.
• Your child needs to take antibiotic medicine often.
• Your child has an illness such as inflammatory bowel disease or has other intestinal abnormalities.

What are the symptoms?

Symptoms may include:

• Watery diarrhea, which may be bloody or painful if severe
• Fever
• Loss of appetite
• Nausea
• Belly pain and tenderness

How is it diagnosed?

The healthcare provider will ask about your child's symptoms and medical history and examine your child. Tell your child’s healthcare provider about all medicines and supplements your child takes.

Your child’s bowel movements may be tested for bacteria. These tests can also show which antibiotic medicine is best to treat the infection.

How is it treated?

For mild symptoms caused by an antibiotic medicine your child has been taking for another infection, the provider may have your child stop taking the medicine. For more severe symptoms, your child may need to be treated with an antibiotic medicine that kills C. diff. Your child may need to stay in the hospital with IV medicine and fluids.

If the lining of your child’s colon has been badly damaged by the infection and your child is severely ill, your child may need surgery to remove the injured part of the colon.

How can I take care of my child?

Follow the healthcare provider’s instructions. Make sure that your child takes all medicines exactly as prescribed. If your child stops taking the antibiotic medicine too soon, the infection may come back.

• If your child has mild symptoms, here are some things you can do to help your child feel better:
  • Your child may eat soft, plain foods. Good choices are soda crackers, toast, plain noodles, rice, cooked cereal, applesauce, and bananas. Avoid foods that are hard to digest or may irritate your child’s stomach including foods with acid such as tomatoes or oranges, spicy or fatty food, meats, milk products, and raw vegetables. Your child may be able to go back to a normal diet in a few days.
• Don’t give aspirin, ibuprofen, or other nonsteroidal anti-inflammatory drugs (NSAIDs) without checking first with the healthcare provider. NSAIDs, such as ibuprofen, naproxen, and aspirin, may cause stomach bleeding and other problems. Check with the healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye’s syndrome.

If your child has severe diarrhea, the body can lose too much fluid and your child can get dehydrated. Dehydration can be dangerous, especially for children. Your child may also be losing minerals that the body needs to keep working normally. Try to get your child to drink extra liquids to replace the fluids and minerals lost. One way to tell if your child is drinking enough liquid is to look at the color of your child’s urine. It should be clear to light yellow.

• If you are not breastfeeding, give your child an oral rehydration solution (ORS) such as Pedialyte. An ORS is a mixture of fluids, minerals, sugar, and salts that replaces fluid lost by vomiting or diarrhea. You can buy these products at drug and grocery stores.
• If you are breastfeeding and your baby is urinating less often than normal, offer an ORS between breastfeedings for the first 6 to 24 hours.
• If your child is over 1 year old, give an ORS. You can also try giving your child water, apple juice mixed with water, ice chips, or frozen ice pops.

Ask your child’s healthcare provider:

• How and when you will get your child’s test results
• How long it will take your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent C. diff infection?

C. diff can be a serious health threat to you and the people around you. It cannot be treated with the usual antibiotic medicine used to treat infections. Prevention is important. Do not use antibiotic medicine for viral colds and flu.

If your child has C. diff, your child can avoid passing it to others by cleaning his or her hands well with soap and water. Everyone who comes in contact with your child must also clean their hands before and after contact.

To avoid getting a C. diff infection:

• Make sure that your child washes his or her hands every time your child uses the bathroom and before eating a snack or meal.
• Make sure that your child takes antibiotic medicine only when needed and only as directed by the healthcare provider who is treating the infection. Have your child finish prescriptions, even if your child feels better. If your child stops taking the medicine too soon, it may not kill all of the bacteria and your child may get sicker.
• If your child is being treated at a hospital, make sure that all doctors, nurses, and other healthcare providers clean their hands with soap and water before and after caring for your child. If you do not see providers clean their hands, ask them to do so.

If your child is at high risk for infection, your child may be advised to take a supplement that may help keep a healthy balance of bacteria in the colon. Research continues to be done on substances, such as probiotic bacteria, to see if they can help prevent or treat C. diff.