Category Archives: C-Diff

C-diff Awareness Virtual Walk: Wrapping Up!

Wrapping up for the day! We checked out the progress on the Arts Center. We clocked 5 miles total for the day.

CdiffAwareness info:

⬆️ CDI incidence and severity have increased in recent years.

🦠 The increased incidence and severity are partially due to an epidemic strain, BI/NAP1/027, which produces higher toxin levels and is highly resistant to fluoroquinolones. Luckily, I tested negative for this super-strain! It’s much harder to kick!

➡️ ETA: the length and severity of the illness depends on a lot of factors. Everyone responds differently to a c-diff diagnosis because there are a lot of different strains of toxigenic c-diff. Some release Toxin A, some release Toxin B, some release both. Some are simply more virulent than others. And they can be life-threatening.

💊 The most important modifiable risk factor for C. difficile infection is antibiotic exposure; this risk is dose-related and higher with longer courses and combination therapy.

💊 Antibiotics in these classes are regularly linked to CDI:

➡️ Clindamycin (Brand name Cipromycin®)
➡️ Fluoroquinolones (Levaquim®)
➡️ Cephalosporins, such as cefalexin (Keflex® and Daxbia®)
➡️ Penicillins

💊 Although even single doses of prophylactic antibiotics can cause CDI, the more antibiotics you use, the greater number of doses, and the longer you take them, the greater the risk. Again, don’t be afraid to ask if three days will do. 10-14 days is a standard that isn’t always necessary (especially with those dental procedures I mentioned earlier). Also, combos aren’t always necessary. Don’t be afraid to ask why they want you on two simultaneously or back to back.

🏨 CDI is also associated with older age, recent hospitalization, multiple comorbidities, use of gastric acid blockers, inflammatory bowel disease, and immunosuppression.

➡️ It has become more common in younger, healthier patients in community settings. A recent study in Minnesota found that 41% of cases of c-diff were community acquired.

➡️ Over and over, the people in my support group said these things: ask questions; question everything; don’t just accept what you’re told; don’t let them put your concern off as NBD (esp. women!); be your own best advocate; do your own research.

➡️ Your average doctor still knows very little about c-diff. GIs know more than PCPs, and IDs know more than both, and even then, well, they’re not always up to date on the latest research and recommendations. It’s your body, your health, you know it, and you fight for it.

🙏 Thanks for doing the C-diff Foundation Awareness Virtual Walk with me! And thanks for all the questions and discussion. I’ve been sharing my journey on my blog as well…lots more research there.

💁‍♀️ I’m almost 11 months post-treatment. It can take 1-3 years for the gut to fully recover depending on the length and severity of the original illness. Isn’t that nuts?! But today we can walk five miles. And I’m not trying to eat bananas and rice. I had duck eggs and toast with peach jam for breakfast. 🙂

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C-diff Virtual Awareness Walk: More C-diff Facts

Went to the Farmer’s Market and did a walk around town. #aDogCalledOamley is at 4 miles with me today. There’s a time I didn’t think I’d ever be able to do that again. I thought I would die. I didn’t. Yay!

Some more #cdiffawareness facts:

💦 C. diff is found throughout the environment in soil, air, water, human and animal feces, and in contaminated food products.
🥩 In one study, 42% of sample supermarket meat contained toxigenic C. diff bacteria.
🕜 The timeline between consuming C. diff infected meat and becoming symptomatic could be years.
♨️ Recommended cooking temperatures and times may not kill C. diff. Because it is a spore, C. diff can survive for up to two hours at the recommended internal temperature of 160 degrees Fahrenheit (71 degrees Celsius).
🤝 C. diff may be spread by a simple handshake.
👥 CDI can affect ANYONE.
⬆️ In recent years, both postpartum women and healthy adults have seen increased risk for CDI. There are several women in my group who contracted c-diff after giving birth.

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C-diff Awareness Virtual Walk: Bleach

C-diff is an infectious disease. It is highly contagious and spreads easily (which is why healthcare settings are problematic).

🦠 A c-diff spore can live inside a bottle of hand sanitizer, no problem, for at least 5 months. True story.

🧴 And all those cleaners (like the one on the far right) that say they kill 99.9% of germs can’t touch c-diff. It IS the 0.1%.

💀 The only way to kill it on surfaces (where, again, it can live for a minimum of 5 months and as much as a year or more) is with germicidal bleach. Which FTR is expensive and was very hard to come by when I was at my sickest because of COVID. The alternative is a 9:1 water + disinfecting bleach mix made daily.

💁‍♀️ I dragged myself around the house with a bottle of Pedialyte in one hand and my homemade bleach in the other. Lost a lot of clothes to bleach.

☑️ But so far: no relapse and Trent has stayed healthy.

cdiffawareness

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C-diff Awareness Virtual Walk: Dentists and Broad-spectrum antibiotics

Oakley did 2.5 miles with me. I can’t tell you how many people have said they developed CDI after a dental procedure. Dentists often prescribe broad-spectrum antibiotics like Clindamycin prophylactically. That is, they give you an antibiotic in case you might get an infection. Unnecessary antibiotic use leads to antibiotic resistance and microbiome disruption, which can lead to a life-threatening c-diff infection. Beware. Ask if you really need that antibiotic. Ask if a shorter course of antibiotics would do. Take a probiotic supplement with it. Protect yourself. Advocate for yourself. #cdiffawareness

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C-Diff Awareness Virtual Walk

Got my shirt, and I’m ready to [virtually] walk for awareness tomorrow. I’ll be sharing c-diff facts on my social media to help raise awareness. I’ll also be sharing things people in my support group say they wish people knew. Here’s a start:

🦠 Half a million Americans a year experience CDI (C. diff (clostridioides difficile infection).
🦠 Most cases of C. diff infection occur while you’re taking antibiotics or not long after you’ve finished taking antibiotics.
🦠 My fellow survivors warn you: if they had to do it over, they would NEVER have taken Clindamycin, a broad-spectrum antibiotic that is a high offender for CDI. They’ve literally started a petition to ban Clindamycin. And some of them have had it permanently marked (upon advice of their doctors) as an allergy on their medical records. Spoiler alert: Cipro and Clindamycin are now no-nos on my MyChart!
🦠 C. diff can be life-threatening.
🦠 About 1 in 6 patients who get C. diff will get it again in the subsequent 2-8 weeks. This is often the start of a recurrent cycle of infections that cannot be cured by antibiotics.
🦠 One in 11 people over age 65 diagnosed with a healthcare-associated C. diff infection die within one month.
🦠 C. diff used to be considered an infection that affected only the elderly, those in assisted living, or those in hospitals. But community spread is substantially increasing. Young people are contracting it more and more. So many people in my survivors group are under the age of 40.

Stay tuned…

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This Time Last Year

At this point last year I had no idea how bad things were going to get. Run down by stress, overworked and overwhelmed, low on sleep and bad on nutrition, I thought I’d just conquered one viral infection and then one bacterial infection only to be hit with a mild case of food poisoning. I thought I ate something that disagreed with me, and it would pass as these things are wont to do. I had no idea that I’d been inadvertently exposed to a potentially deadly infectious bacterial disease. I had no idea that I would suffer for more than a week before getting a telehealth appointment (thanks, COVID) where my doctor would tell me it’s “probably salmonella. There’s an outbreak in your area. But you’re young and healthy, so it will probably pass in a few more days.” I believed that was true. It wasn’t. I had no idea how bad it would get. I didn’t know anything about c-diff (color me a lay expert now!). It would be weeks more before I’d get the right tests, a diagnosis, and a[n inappropriate and outdated] first treatment. In the meantime, I’d be treated for salmonella, get tested for it and a variety of other infections, parasites, bacteria…and discover an allergy to Cipro. I would lose 40 pounds, quickly, within a month. I would find myself unable to do the most basic tasks. I’d be unable to eat and retain nutrients. I’d be dehydrated. I would finally get that MyChart message and the subsequent phone call: “immediately stop taking all medication. It’s making it worse. You have c-diff.” I had Googled it by that point and knew enough to cry. I could barely walk to the bedroom to tell Trent. He knew enough to call in to work for me and say I couldn’t be there. And so that journey began. But that’s weeks from this date last year when I had no idea how bad it would get.

On this day this year, I struggled. In ways I’d never have imagined a year ago. But I’m going to bed #grateful for progress; a new year; better health (still 🤞🤞🤞). Also, I’m kind of grateful I didn’t know then what I know now… I might not have had the strength to keep pushing on. #ThisIs41 #Healing2021

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Two successes: Tomatoes and Gruyere

Two things: 1) I added some (not too many!) cherry tomatoes when I was cooking my vegetable khichdi for the week. I ate it for lunch 4 times. I also put a tiny tomatoe slice on a sandwich earlier this week. And…nothing bad happened! 🥳 2) I’m so exhausted. Work is crazy. I slept for 9 hours the other night! I am so tired of having to prepare 3 meals a day for every day from scratch in my own kitchen. So I gave takeout another go. Last time did not end well. So we again scoured a menu for something we thought I could try and then I made some custom requests: whole grain bread instead of brioche; no butter for grilling; no sauce with milk. It’s a Ham & Gruyere Melt. I researched gruyere, and apparently it’s lactose free. So I had this sandwich (well, not the whole thing because it’s huge) for lunch today. Fingers crossed it goes well! So far, so good, but tomorrow will be the real tell. It will be such a relief to find at least one takeout thing I can eat! I’m almost 10 months post-treatment. Tuesday will be the anniversary of my first bacterial infection diagnosis and treatment (Flagyl) which started this whole roller coaster. That’s getting in my head obviously. Focusing on my gratitude though! And the tomato success is on the list!

Vegetable Khichdi with a few tomatoes
Ham and gruyere sandwich from First Watch

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ACG Guidelines: Vancomycin as Prophylactic

The American College of Gastroenterology released new guidelines recently. They’re not terribly exciting, and we’ve talked before about how the treatment guidelines differ from those of the The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). ACG still recommends Vancomycin as first line while IDSA and SHEA went ahead and bumped Dificid to the front of the line. The difference being negligible really, and doctors from both saying either set of guidelines could really be equally effective.

But what I did find interesting here (that I don’t think we’ve discussed) is that they are finally officially recommending Vancomycin as a prophylactic for people with a history of CDI. This should make it easier to convince doctors to give this treatment alongside post-CDI antibiotic use. Some doctors have still been reluctant to do this despite research showing it works (which we’ve talked about before). And many flat-out refuse to do it.

From the article:

“In patients with a history of CDI who are at an increased risk for recurrence, to prevent further recurrence, oral vancomycin prophylaxis (OVP) may be considered during subsequent systemic antibiotic use. When prescribing OVP, using low-dose vancomycin 125 mg once daily is suggested. In most cases, this treatment is continued until 5 days following completion of systemic antibiotics.”

research

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Why FMT Fails Some People

Some new research into why FMT fails for some people:

“Although [FMT] is a powerful therapy for individuals who develop recurrent CDI (rCDI), 10% to 15% of patients still fail to recover following FMT”

Researchers have identified a number of risk factors for treatment failure after fecal microbiota transplantation (FMT) for Clostridioides difficile infection (CDI), some of them modifiable.

“In univariate analyses, poor cleansing of the transverse colon (P=0.043) and narcotic use were significant predictors of rCDI after successful FMT (P=0.039).”

“In multivariate analyses, the presence of diabetes predicted initial FMT failure (odds ratio [OR], 0.03; 95% CI, 0.001-0.81), and failure to deliver transplanted stool to the terminal ileum predicted rCDI after initial success (OR, 0.81; 95% CI, 0.66-0.99).”

“Of 26 different risk factors identified in the studies, the current meta-analysis identified inpatient FMT administration (OR, 5.2; 95% CI, 3-8.92), older age (OR, 1.05; 95% CI, 1.021-1.086) and the presence of IBD (OR, 5.2; 95% CI, 2.53-10.67) as predictors of failure. Other predictors of FMT failure included early antibiotic use after FMT (OR, 4.73; 95% CI, 1.77-12.65), immunosuppression (OR, 3.85; 95% CI, 1.85-8), higher Charlson Comorbidity Index scores (OR, 1.34; 95% CI, 1.1-2.87) and the presence of pseudomembranes at the time of FMT (OR, 4.681; 95% CI, 1.79-12.25).”

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This article was in my morning reading feed. I have worked really hard on chewing properly! It’s amazing what a difference that makes. It’s helped with acid reflux and with general digestion. I take much more time to eat now than before. Such a small thing but big difference. I’ve also been careful about the times of day I eat, and I’m a big fan of the benefits of fiber (as many of you have heard me say over and over). There’s some good points here about sleep and stress (and general mental health and we’ll being).

The one thing I haven’t heard of or tried is Panta Bhat (fermented rice). Obviously, I know fermented foods are good for digestion and for a healthy gut, but I had never heard of fermented rice. Super simple to make, so I might give it a try.

On a different note, I’m over 9.5 months post-treatment. This time of year is when I first started getting sick. My first antibiotic was prescribed August 31. It was all downhill from there! Stress is real right now with my work life, so I’m trying to remember to manage that because it’s important for my gut. I’ve been using Banatrol as a preventative pretty regularly lately just because I don’t think my mental health can handle any PI-IBS flares right now. Anyway…onward!

https://www.freepressjournal.in/lifestyle/8-best-ways-to-improve-your-digestion

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