In the world of healthcare, the night can be filled with unexpected challenges and remarkable stories of resilience. This post will cover my new job at UTSW and display a night that remains etched in my memory: the fierce battle against the formidable enemy Clostridium difficile or C. difficile, which took place over three consecutive nights. It was an evening that not only tested my medical skills but also taught me valuable lessons about compassion and determination. In this blog post, I invite you to enter a dimly lit hospital room where the pungent odor of C. difficile has been paused and join me in my journey of patient care.
Walking into the room that night, the first thing that caught my eye was an unmistakable stench – the characteristic odor of C. difficile infection. The patient, let’s call him Mr. Anderson, has been battling this drug-resistant bacteria for days, and the room is a witness to the ongoing struggle. My first instinct was to put on the necessary personal protective equipment (PPE) – gloves, gown and mask – to protect myself from highly contagious bacteria. What made this evening all the more difficult was Mr. Anderson’s special condition. Together with C. difficile, he battled the effects of MRSA (methicillin-resistant Staphylococcus Aureus), adding another layer of complexity to his medical journey. In the next article, I will start discussing MRSA. But the real challenge lies in the tracheostomy tube – a lifeline that helps him breathe but creates a silent barrier to communication. His voice was silent and we had to rely on nonverbal cues and sometimes scribbled lines to understand his needs and concerns.
Add to that Mr Anderson’s medical complexity, the fact that he lost a leg and his physical limitations add to the challenge of daily activities and as a caregiver it is my responsibility to ensure his comfort and dignity.
Despite the adversity, the goal was clear: to provide the best possible care for Mr. Anderson. We have carefully managed C. difficile, implementing strict infection control procedures. The stench, although still lingering, became a secondary concern when we focused on his health. We’ve taken extra steps to keep him comfortable, adjust his bed and make sure he can take pain medication when needed.
The Story behind C. Diff
Clostridium difficile, a bacterium that later became a significant health concern, was first isolated and identified by Hall and O’Toole in 1935. It was initially observed in the feces of healthy babies. However, at this early stage, C. difficile is not associated with disease and is considered a normal component of the gut microbiota.
The species name “ difficile” was chosen because of the difficult nature of bacteria. He has a reputation for being difficult to work with in the lab, which influenced the choice of the name. Despite the initial discovery, C. difficile remained relatively obscure in the microbiological world for decades.
The link between C. difficile and the disease became clearer in the late 19th century, when pseudomembranous colitis was first described in 1893. However, it was not until 1978 that researchers, including George and his colleagues, definitively concluded C. difficile with pseudomembranous colitis, a severe inflammatory bowel condition characterized by the formation of pseudomembranes (fake membranes of the colon). The late 20th century marked the emergence of C. difficile as an important nosocomial infection. Researchers and clinicians have begun to recognize its role in antibiotic-associated diarrhea, particularly in healthcare settings where antibiotic use is common. C. diff infection is associated with disruption of the intestinal flora caused by antibiotic treatment, which allows bacteria to grow.
In response to the growing concern surrounding C. difficile infection, various treatments have been developed. These include antibiotics such as metronidazole and vancomycin, as well as fecal microbiota transplants (FMTs), which aim to restore a healthy gut microbiome. C. difficile remains a dynamic and evolving topic in the field of infectious diseases and nosocomial infections. Ongoing research is focused on understanding genetics, transmission, and exploring new treatment strategies. In healthcare settings, infection control measures, including hand hygiene and prudent use of antibiotics, are essential to preventing the spread of C. difficile infection.
The Medical Humanist 
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