An overview of Clostridioides difficile and faecal microbiota transplant: implications for nursing practice
Clostridioides difficile bacteria can cause excessive diarrhoea in patients, leading to further complications, such as severe dehydration and sepsis. Although C.difficile bacteria tend to reside harmlessly in many people's bowels, prolonged antibiotic use can alter the bacterial balance of the bowel resulting in a C.difficile infection. Guidance from the National Institute for Health and Care Excellence recommends treating a C.difficile infection with further antibiotic therapy; however, it also states that in cases of recurrent infection, a faecal microbiota transplant (FMT) should be considered. This article focuses on the treatment modality of FMT and is aimed at increasing awareness of the treatment. As well as discussing how the nurse can approach the topic with a patient considering FMT, the article also considers the nurse's role throughout the process.
Clostridioides difficile, previously known as Clostridium difficile and sometimes referred to as ‘C.diff’, is a Gram-positive bacillus that is also anaerobic, toxin-producing, and spore-producing. The spores are commonly transmitted via the faecal-oral route, making it one of the most widely present pathogens in the physical environment, particularly where hand hygiene practices are not correctly applied, or where the cleaning products used are ineffective, leading to the spread of C.difficile. This is compounded by figures that suggest 3% of adults and up to 66% of children are carrying C.difficile at any one time, with this figure rising among care home residents and hospitalised patients (UK Health Security Agency, 2022). Typical sources of C.difficile infection tend to be asymptomatic carriers, those who are infected, the environment, and the animal intestinal tract (Czepiel et al, 2019).
C.difficile infection tends to manifest itself in patients through watery diarrhoea, fever, reduced appetite, nausea, and abdominal pain/tenderness. Where C.difficile infection is suspected, it is vital that a stool sample is sent for further testing as soon as possible (National Institute for Health and Care Excellence (NICE), 2021); however, to reduce any potential false positive results, it is recommended that C.difficile infection testing should not be conducted on any patient who has received laxatives in the past 48 hours, or in any patient that has not experienced at least three unformed stools (types 5-7 on the Bristol stool chart) in the past 24 hours.
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