Abdominal pain and diarrhea had taken over Mary’s* life. Every few hours, she had to rush to the restroom, a pattern that eventually led to her losing her job. Worst of all, she couldn’t spend time with her grandchildren because she feared they’d also get sick.
When she went to her appointment to see Teena Chopra, M.D., MPH, an infectious disease specialist and professor of medicine at Wayne State University in Detroit, tests revealed the cause of her condition was a bacterial infection called Clostridioides difficile or C. diff. The infection caused her to develop colitis, an inflammation of the colon, which triggered the diarrhea and abdominal pain.
“C. diff [infection] has been around for years, but it’s increased in prevalence because we’re using a lot of antibiotics and because more people are being exposed to the hospital environment,” Chopra said. “As we get older, we’re also more susceptible because our immunity is down. It’s a nuisance disease because it causes diarrhea and affects people’s quality of life.”
C. diff is the most common healthcare associated infection in the U.S., with nearly half a million cases and as many as 30,000 deaths reported each year. What worries healthcare providers (HCPs) and researchers now is the rise in recurring infections, putting C. diff in the category of infections considered urgent public health threats by the Centers for Disease Control and Prevention.
How C. diff infections happen
Our bodies have trillions of bacteria, and the majority of our bacteria in our gut make up what’s called the gut microbiome. Our organ systems depend on a balanced microbiome to keep us healthy.
When bad bacteria like C. diffovertake healthy bacteria, dysbiosis, a technical term for an imbalance in the gut microbiome, can occur. A healthy microbiome can prevent C. diff from multiplying in the gut, but if there’s an imbalance, C. diff bacteria can grow. That leads to the production of toxins that cause an inflammatory response in the colon, and can trigger debilitating symptoms, such as diarrhea, fever, stomach tenderness or pain, loss of appetite and nausea.
C. diff bacteria can be all around us, but an infection most often happens when people are taking antibiotics. Antibiotics kill the bad bacteria in your gut, but they can also kill the good bacteria that help prevent infections. People can also get a C. diff infection from surfaces or objects that contain C. diff spores, which can last on surfaces for a long period of time.
Autoimmune diseases, HIV and cancer are among the conditions that can disturb the gut microbiome, but so can treatments like chemotherapy and steroids. Simply being in the hospital, a clinic environment or long-term care facility can put you at risk for a C. diff infection. Many people who spend significant amounts of time in healthcare settings already have weakened immune systems, making them more at risk for infection. Even those who work as HCPs could face a greater risk for C. diff infection due to increased exposure.
The unique C. diff infection burden for women
Anyone can get a C. diff infection but certain biological, physical and lifestyle factors put women at a higher risk. These factors include:
- Biology: Women’s reproductive anatomy makes it more likely they’ll develop conditions that need antibiotic treatment, such as bacterial vaginosis and urinary tract infections. Many cases of C. diff infection happen after taking antibiotics because these medications can destroy the good bacteria that helps fight infection, along with the bad bacteria.
- Pregnancy and childbirth: Immune system changes that take place during pregnancy raise the chance of bacterial infections that lead to antibiotic treatment. Women who have cesarean deliveries are also at greater risk for hospital-associated infections because of the surgery, longer hospital stays and use of antibiotics. There has also been an increase in the number of postpartum women with C. diff infection, likely because they were exposed during their hospital stay.
- Exposure to healthcare environments: Everyone has healthcare appointments, but women typically have more exposure to healthcare settings because they see their HCP in the office more often than men. Also nearly 9 out of 10 percent of nursing, psychiatric and home care aides in institutional and home- and community-based settings are women.
- Autoimmune diseases: Women are more likely to have autoimmune diseases, including multiple sclerosis and rheumatoid arthritis, and steroids are often given as treatments. Steroids suppress the immune system to fight disease, which means they can also make people more at risk for C. diff infection.
- Caregiving roles: More women are caregivers than men, which can put them at risk for C. diff infection because they have more exposure to hospitals and healthcare facilities as part of their caregiving duties.
- Socioeconomic status: Women from underserved communities might face a delay in getting diagnosis and treatment. “It’s important to highlight social determinants of health in women of color and lower-income women,” Chopra said. “There may be a lack of trust in healthcare systems [among these communities], so it’s important to have more awareness and education around C. diff infection.”
- Age: Older age puts everyone at greater risk for C. diff infection because of a decreased ability to mount a strong immune response to a bacterial infection.
Take care of yourself
Awareness of C. diff infection and its risk factors can help women lessen their risk of getting the infection and help them receive the right treatment if they contract it. If you’re experiencing ongoing diarrhea, fever, stomach tenderness or pain, loss of appetite or nausea, you should ask your HCP for a specific C. diff infection test.
You can reduce your risk for C. diff infection by washing your hands with soap and water. The friction from rubbing removes the spores. Surface areas and bathrooms should be cleaned with bleach — the only agent that can help get rid of C. diff bacteria.
If you have an active C. diff infection, these practices are even more important because C. diff spores can live on surfaces for months.
Lifestyle changes, such as a healthy diet and exercise, are also important for maintaining a healthy gut microbiome. Chopra said a diverse diet with more plant-based foods and fermented items can help. And it’s also important to avoid foods and beverages high in sugar because gut bacteria feed on sugar. Exercise can also promote positive changes in the gut microbiome.
These changes can help reduce the risk of infection and help improve your health overall, Chopra said. She added that it’s important for women — who are everything from caregivers and moms to CEOs — not to forget about their own lifestyle and health.
*Mary is not her real name.
This educational resource was created with support from Ferring Pharmaceuticals USA.
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