Learn more about this diarrhea-causing infection that often occurs after antibiotic use. Many, but not all, affected people are in health care facilities.
Clostridioides difficile (klos-TRID-e-oi-deez dif-uh-SEEL) is a bacterium that causes an infection of the large intestine (colon). Symptoms can range from diarrhea to life-threatening damage to the colon. The bacterium is often referred to as C. difficile or C. diff.
Illness from C. difficile typically occurs after use of antibiotic medications. It most commonly affects older adults in hospitals or in long-term care facilities. In the United States, about 200,000 people are infected annually with C. difficile in a hospital or care setting. These numbers are lower than in previous years because of improved prevention measures.
People not in care settings or hospitals also can develop C. difficile infection. Some strains of the bacterium in the general population may cause serious infections or are more likely to affect younger people. In the United States, about 170,000 infections occur annually outside of health care settings, and these numbers are increasing.
The bacterium was formerly named Clostridium (klos-TRID-e-um) difficile.
Some people carry C. difficile bacteria in their intestines but never become sick. These individuals are carriers of the bacteria and may spread infections.
Signs and symptoms usually develop within 5 to 10 days after starting a course of antibiotics. However, they may occur as soon as the first day or up to three months later.
The most common signs and symptoms of mild to moderate C. difficile infection are:
People who have a severe C. difficile infection tend to become dehydrated and may need to be hospitalized. C. difficile can cause the colon to become inflamed and sometimes form patches of raw tissue that can bleed or produce pus. Signs and symptoms of severe infection include:
C. difficile infection that is severe and sudden, an uncommon condition, may also cause intestinal inflammation leading to enlargement of the colon (also called toxic megacolon) and sepsis. Sepsis is a life-threatening condition that occurs when the body's response to an infection damages its own tissues. People who have these conditions are admitted to the intensive care unit.
Some people have loose stools during or shortly after antibiotic therapy. This may be caused by C. difficile infection. See your doctor if you have:
C. difficile bacteria enter the body through the mouth. They can begin reproducing in the small intestine. When they reach the large intestine (colon), they can release tissue-damaging toxins. These toxins destroy cells, produce patches of inflammatory cells and cellular debris, and cause watery diarrhea.
When the bacteria are outside the colon — virtually anywhere in the environment — they are in a dormant state, or essentially shutdown. This enables them to survive for a long time in any number of places:
When bacteria once again find their way into a person's digestive system, they "wake up" and can begin to produce infection again. The ability of dormant C. difficile to survive outside the body enables the generally easy transmission of the bacterium, particularly in the absence of thorough hand-washing and cleaning.
Although people who have no known risk factors have gotten sick from C. difficile, certain factors increase the risk.
Your intestines contain about 100 trillion bacterial cells and between 500 to 2,000 different kinds of bacteria, many of which help protect your body from infection. When you take antibiotics to treat an infection, these drugs tend to destroy some of the helpful bacteria in your body in addition to the bacteria causing the infection.
Without enough helpful bacteria to keep it in check, C. difficile can quickly grow out of control. While any antibiotic can be implicated, the antibiotics that most often lead to C. difficile infection include:
Proton pump inhibitors, a type of medicine used to reduce stomach acid, also may increase your risk of C. difficile infection.
The majority of C. difficile infections occur in people who are or who have recently been in a health care setting — including hospitals, nursing homes and long-term care facilities — where germs spread easily, antibiotic use is common and people are especially vulnerable to infection. In hospitals and nursing homes, C. difficile spreads on:
Certain medical conditions or procedures may make you more susceptible to a C. difficile infection, including:
Older age is a risk factor. In one study, the risk of becoming infected with C. difficile was 10 times greater for people age 65 and older compared with younger people.
Having one C. difficile infection increases your chance of having another one, and the risk continues to increase with each infection.
Women are more likely than men to have C. difficile infection, for reasons that are not clearly understood.
Complications of C. difficile infection include:
To help prevent the spread of C. difficile, hospitals and other health care facilities follow strict infection-control guidelines. If you have a friend or family member in a hospital or nursing home, follow recommended practices. Ask questions if you observe caregivers or other people not following guidelines.
Preventive measures include:
A diagnosis of C. difficile infection is based on the presence of:
People who have regular, formed stools should not be tested for C. difficile infection. Recent use of antibiotics is not required for making a diagnosis of C. difficile infection.
If C. difficile infection is suspected, your doctor will order one or more laboratory tests of a stool sample. These tests identify either the toxins or strains of the bacteria that produce toxins.
In rare instances, to help confirm a diagnosis of C. difficile infection and look for alternative causes of your symptoms, your doctor may examine the inside of your colon. This test (flexible sigmoidoscopy or colonoscopy) involves inserting a flexible tube with a small camera on one end into your colon to look for areas of inflammation or abnormal tissue.
If your doctor is concerned about possible complications of C. difficile infection, he or she may order an abdominal X-ray or a computerized tomography (CT) scan, which provides images of your colon. The scan can detect the presence of complications such as:
Treatments are used only if a person has signs or symptoms of infection. People who carry the bacteria — but are not sick — are not treated.
If C. difficile infection is related to an antibiotic you're taking, your doctor will likely discontinue use of that drug. In many cases, however, an antibiotic treatment is critical for treating another infectious condition. Your doctor may prescribe a different antibiotic that is less likely to contribute to diarrhea related to C. difficile infection.
Antibiotics are the mainstay to treat C. difficile infection. Commonly used antibiotics include:
Metronidazole (Flagyl) may be used in combination with vancomycin to treat serious C. difficile infection.
Surgery to remove the diseased portion of the colon may be necessary in some cases, including:
Approximately 25% of people treated for C. difficile infection get sick again, either because the initial infection never went away or because they've been reinfected with a different strain of the bacteria. The risk increases with each C. difficile infection episode and exceeds 50% after three or more infections.
Your risk of recurrence is higher if you:
Treatment for recurrent disease may include the following strategies.
Fecal microbiota transplant (FMT). FMT is an emerging treatment for multiple recurrent C. difficile infection that has been studied in clinical trials. The U.S. Food and Drug Administration has not approved FMT but allows the use of FMT for C. difficile infection as an experimental procedure. You need to sign an informed consent about the benefits and risks of the experimental procedure. FMT is also called a stool transplant or an intestinal microbiota transplant.
FMT restores healthy intestinal bacteria by placing another person's (donor's) stool in your colon with specialized tubes inserted through your rectum. Donors are screened for medical conditions, their blood is tested for infections, and stools are carefully screened for parasites, viruses and other infectious bacteria before being used for FMT.
Research has shown that FMT done one or more times has a success rate higher than 85% for treating recurrent C. difficile infections.
Supportive treatment for diarrhea includes:
August 28th, 2021