Caitlin McClain, Peggy Lillis Foundation Board Member, Shares Her Experience With C difficile

Caitlin McClain, a Clostridioides difficile (C difficile) survivor, nurse, and board member and advocate for the Peggy Lillis Foundation, shares her experience having the infection.

In March 2024, McClain, then 34 years of age with no risk factors, was diagnosed with acute uncomplicated diverticulitis and prescribed a 10-day course of ciprofloxacin and metronidazole. By day 5, she developed abdominal pain, cramping, and diarrhea, which clinicians attributed to lingering inflammation and later to irritable bowel syndrome. With a gastroenterology appointment scheduled 9 months out, her symptoms worsened through the summer. After a COVID-19 infection in August, an emergency department suggested anxiety and discharged her without labs. Days later, a different emergency department found septic shock, renal failure, toxic megacolon, and a positive C difficile test.

Because of an allergy to vancomycin, McClain was treated with fidaxomicin and received 2 fecal microbial transplants (FMTs) in the same week, shortly before OpenBiome stopped distributing donor stool. Her symptoms returned the day after Thanksgiving, and the on-call gastroenterologist warned that her treatment options were running out. Using her Veterans Affairs and military coverage, she was referred to Monika Fischer, MD, at Indiana University, who was conserving donor stool as access tightened and in turn referred her to Mayo Clinic.

At Mayo Clinic, Sahil Khanna, MD, identified her years as a nurse as a risk factor for colonization and advised that she likely could not return to bedside nursing. Labs revealed dangerously low potassium and almost no white blood cells. After another 10 days of antibiotics and rigorous home decontamination, she underwent donor-directed FMT via endoscopy and colonoscopy. Despite complications from her weakened state, she has remained C difficile–free since.