RN with relapsing cdiff

I have a lot of experience with this. I'm a nurse who worked in the ICU. Cdiff spores are all over the place, everyone working in the hospital probably has them. When you take a lot of ABX, escpecially certain ones, the spores germinate and cdiff toxin attacks your colon and you get sick. The spores live for two years in your colon, and usually a year on inorganic surfaces (curtains, tabletops), and are very hard to disinfect. I initially got ill from taking clindamycin (known to cause cdiff), and unfortunately didn't know it was cdiff. I was put on other abx, they were thinking I contracted some bacteria from mexico. This only made the cdiff worse, gave me an allergic reaction to the toxins and everything. So I was sick for about a month with diarrhea. I was told to try different things, like immodium (antidiarrheals make it worse and multiply faster), lactobacillus because they thought I had just wiped out my normal flora. Well, I finally became dehydrated and in pain enough that I passed out transporting a patient at work one day. I was up to like 14 stools of water a day, and ended up being rehydrated in the ER with 5 liters before my mucosa started to look more hydrated. Why didn't I realize this, why didn't my family doctor? I had good days and bad days and was so busy that it didn't occur to me. I ended up getting a scope.

So, there is a very bad strain of cdiff going around. Yes, it is extremely important to was hands and use contact precautions so you don't spread it to other patients. But the truth is, all of us healthcare workers have the spores if we work around cdiff patients. I spoke with the ID doctor at our hospital trying to figure out how I got it. He said he wasn't surprised at all, and if you cultured the unit phones they would be crawling with cdiff.

When you let cdiff get bad, like I did, it takes a while to get rid of it. Flagyl never worked for me, besides the fact it made me really nauseated. Vanco works great, but you will need more than a two week treatment to get rid of it. It has to be PO vanco, and this doesn't get absorbed systemically.

#1- don't take pepto bismol, immodium, or other antidiarrheals, it will make the cdiff worse.

#2- you need to take a form of lactobacillus to keep the good flora in your intestines at normal levels to combat the cdiff and make you less susceptible in the future from getting it. In the future, if you feel your immune system low, it may be a good idea to take a month's worth of it to keep you safe. There is a great brand that doesn't need to be refridgerated. It's called culturelle. You can get it at a walgreens, usually in the herbal section.

#3- The symptoms will last for a while, even though you may be free of it. This happened to me.

#4- You are probably experiencing problems and symptoms now because you either got a really bad case of it, let it go on too long without treatment, or are dehydrated. You need to keep hydrated with this. I lost 15 pounds in a month even with trying to keep myself hydrated.

#5- I hate to say it, but a bland diet is what you need for a while. Yogurt is great because of the cultures in it.

#6- Make sure you have a good GI doc. Don't rely on a family doc to treat this.

#7- You shouldn't take any antibiotics for at least two years, until the spores are out of your system. So, take MVI's, especially if you feel yourself getting sick. I take vit c and zinc when I feel myself coming down with something. If you need to take abx, you should also take flagyl and lactobacillus with it to prevent a cdiff outbreak.

#8- If your stomach feels very active, lots of butterflies, excessive bloating and gas, it's a good idea to call your GI doc and send a stool sample in.

#9- If you know it has come back, don't delay. My doc gave me an extra prescription of vanco to keep on hand in case it came back. Early treatment is the key to nipping it in the bud. And those of us who have had it know exactly what it is when it comes back.

Mine came back after a year, I hadn't been taking any antibiotics, I think my immune system was just low, so I immediately started abx and sent in a sample and started feeling better the next day. It'll take a little while to totally get rid of it. Keep your head up, you will get rid of it, you just need to catch it earlier. Don't wait for a week to hear back from stool results, start vanco right away. I never knew how painful cdiff was for my patients until I got it. I actually had gastritis and pseudomembranous colitis because of it. People have been known to get colectomies because of cdiff. It's just not watery diarrhea. People need to treat it more seriously.

this post scares me.

Just attended inservice on c. dif yesterday presented my director of infectious diseases at geisinger medical center, pennsylvania. the # of cases of c. dif among hospitalized patients has doubled nationally since 2000. the c. dif of today is different from the c. dif before 1999. it's genetic make-up has changed. it is much more virulent causing a significant number of deaths among patients; also requiring colectomies in some. it is believed that flouroquinolones are responsible for this genetic change, particular tequin and cipro. the usual treatment of flagyl does not work. the first line drug is vancomycin (it always was but was considered too expensive). "full" dosing for one month, at least -- and then possibly 125mg po QOD. there is no set protocol at this time -- though some hospitals have developed their own. (Johns Hopkins, e.g.) some physicians are "winging it". also, it depends upon the testing method used as to the accuracy of testing for c.dif. the most common method is only 80% accurate. so, recommended if negative, obtain a second, then a third if necessary.
this new strain of c. dif is epidemic affecting at least 50% of elderly hospitalized patients on multiple antibiotics. it is affecting 80% of our patients. relapses occur in at least 30% of those who have it. first seen in new england and quebec. hope this is helpful -- and not too late for you.

To the original poster, you've gotten some great advice already. Just want to say I hope things work out for you.

A quick note about those foam hand cleaner dispensers. They are ineffective against c-diff. You must wash your hands the old fashioned way when dealing with it.

I also just attended an inservice on c. diff and quite truthfully it shook me a bit. My first thought was the big push we have all done on hand hygiene/alcohol hand sanitizer. Did we inadvertently spread the spores? I was very proud of myself for using that gel and praised all employees that I saw using it properly. Any thoughts or am I over thinking in my very tired state?

you are right. that was another important point made by the infectious disease specialist. the increase in c. dif over the past few years may be linked to use of alcohol-based hand gels/foam -- which is ineffective against spores (e.g., c. dif) -- he stressed the need for good handwashing using soap and water when dealing with c. dif.

I'm a microbiologist starting my second career as a nurse. "Hand sanitizers" make me cringe for so many reasons:
-50-70% Alcohol is NOT that effective against a LOT of things. It evaporates too fast to kill a lot of things you want gone. This is a first year biology lab experiment.
-Alcohol dries out your skin, making small cracks that just give infections a new way in
-Wash your darn hands already! Its still the most effective way to protect yourself and everyone around you! Stop trying to KILL the germs and get RID of them down the sink!

I certainly hope your C. Diff. gets better, and that this thread reminds everyone to be careful!

I'm curious if you have any studies to support your post as it contradicts current research and CDC recommendations.

The guidelines that I am aware of recommend alcohol based products as an *adjuct* to regular good handwashing, when you can't wash, not a virtual replacement, which is how I see some (a lot of) people use them.
I think that compliance with the sanitizers probably is higher, and is therefore worth keeping it around, since, its better than nothing. But I am concerned that lots of people don't wash thier hands as often as they should and don't use these alcohol products properly or wash thier hands properly when they do take the time.
God, I better not ever be hospitalized. "You're gonna check me over? Did you wash your hands? No, that wasn't long enough, do it again. Let me see your nails?" I'd be a holy terror.
Maybe we should start hiring bathroom snitches to make sure everyone washes... I'm only half kidding!