C. difficle associated diarrhoea (CDAD)

C. Difficle related diarrhoea is a condition which usually affects older patients who have received antibiotics, however in some circumstances it may affect younger adults who are neither immunocompromised nor receiving antibiotic therapy.

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C. difficle is a bacteria which inhabits the gut of approximately 2-4% of the general population without causing them har or illness. It’s prevalence is even higher in healthcare workers and those residing in long-term healthcare institutions. Most of these individuals are entirely without symptoms. In carriers who are well the proliferation of this organism is held in check by the other organisms (usually between 500 to 1500 different species) within the bowel, a little like a weed that struggles to grow when surrounded by other healthy plants. However in certain settings, such as the administration of antibiotics or chemotherapy the number of healthy organisms drops considerably (perhaps to 200 -300 species) and in susceptible individuals this allows C. difficle to proliferate. The use of prolonged antibiotic courses and multiple antibiotics makes the proliferation of C. difficle more likely. Under these circumstances C. difficle may secrete a number of toxins (Toxin A and Toxin B) which then cause damage and inflammation within the bowel, leading to diarrhoea (C. difficle associated diarrhoea (CDAD)) and systemic upset. In areas where antibiotic use is higher the prevalence of CDAD tends to be higher and the age of onset tends to be lower. In the UK the rates of CDAD are lower than in the USA and the average age of disease onset is considerably older (late seventies as compared to early 60s in the US), perhaps as a result the associated 30 day mortality is considerably higher in the UK.

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Treatment of CDAD may be undertaken using antibiotics for this condition or for those with recurrent disease faecal microbiome transplant (FMT), where another individuals stools are transferred from a “donor” to the patient with diarrhoea.