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Clostridium difficile infection


Expert reviewer, Professor Robert Read, Professor of Infectious Diseases, University Hospital Southampton
Next review due August 2022

Clostridium difficile is a type of bacteria that can infect your bowel and cause diarrhoea, usually after you’ve recently had a course of antibiotics. Its name is often shortened to C. difficile or sometimes C. diff.

C. difficile infection most commonly affects people who are in hospital or long-term care homes, but it can spread to others. It can usually be treated with a different type of antibiotic but sometimes it takes several courses to get rid of the infection completely.

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About clostridium difficile infection

C. difficile bacteria are common — lots of people, especially babies, carry it in their bowel without even realising it. If you’re healthy, this doesn’t usually cause any problems because bacteria that normally live in your bowels keep the growth of C. difficile in balance.

But taking certain antibiotics can disrupt the normal balance of bacteria in your bowel. This allows C. difficile to grow to unusually high levels and produce harmful substances (toxins) that damage your bowel and cause diarrhoea. .

Causes of clostridium difficile infection

Certain factors increase your risk of developing a C. difficile infection. These include if you:

  • have recently taken a course of antibiotics
  • are currently in hospital or you’ve recently had to stay in hospital
  • live in a nursing home
  • are older (usually over the age of 65)
  • have other health problems — such as kidney disease or inflammatory bowel disease
  • take medicines called proton pump inhibitors
  • have a condition that weakens your immune system — for example, if you’re having treatment for cancer or if you have HIV/AIDS

Symptoms of clostridium difficile infection

Symptoms of C. difficile infection may include:

  • diarrhoea, which may be watery and sometimes have blood in it
  • abdominal (tummy) pain
  • a high temperature
  • a tender and swollen abdomen (tummy)
  • feeling sick – although this isn’t common

The diarrhoea will usually start about four to nine days after you started antibiotics — although it can be much later.

The symptoms listed above can also be caused by other infections or illnesses affecting your bowel such as gastroenteritis and irritable bowel syndrome. Some antibiotics and other medications can also sometimes cause diarrhoea, without it being C. difficile.

Most of the time when people get diarrhoea, it clears up on its own and you don’t need to see a doctor. But if you also have pains or develop a fever and you’ve recently been treated with antibiotics, contact your GP.

Diagnosis of clostridium difficile infection

If you see your doctor because you have diarrhoea, they’ll ask you about your symptoms and medical history. They may also want to examine you. Your doctor will want to know the name of any antibiotics you’ve taken and when. If you’re not in hospital already, they’ll also want to know if you’ve had a recent hospital stay.

If your doctor suspects your symptoms could be due to C. difficile, they may ask you for a sample of poo (called a stool sample). This will be sent to a laboratory for testing. The results of the test will tell your doctor if it’s likely that you have C. difficile. Occasionally, your doctor may recommend other tests such as blood tests and scans to confirm a diagnosis.

Treatment of clostridium difficile infection

The treatment for C. difficile will depend on how severe your infection is, and whether you need to stay in hospital or can be treated at home.

General care

  • If you have a severe infection, you may need to be admitted to hospital, if you’re not in hospital already. You’ll need to be isolated in your own room, to prevent the infection spreading to others.
  • If you have mild symptoms, you might be able to have treatment at home.
  • You’ll usually need to stop any antibiotics and sometimes other medication that you’re taking.
  • You’ll need to make sure you drink enough fluids to replace those that you’ve lost as a result of having diarrhoea. If you become severely dehydrated, you may need to have fluids given to you through a drip in your arm.

Medicines

You’ll usually be prescribed another antibiotic to treat the C. difficile infection. This may be metronidazole, vancomycin or occasionally, fidaxomicin. You’ll need to take the antibiotics for between 10 and 14 days. Make sure you finish your course of treatment, even if your symptoms clear up.

Don’t take any over-the-counter anti-diarrhoea medicines. These drugs slow down your diarrhoea, which means your intestine is exposed to the bacteria for longer, potentially causing more damage.

Recurrent infection

There’s a possibility that your infection will come back after treatment or that you may get another one. This happens to about one out of five people who develop C. difficile infection. If your symptoms return, let your doctor know as soon as possible. You may need another course of antibiotics.

Sometimes, C. difficile infections don’t respond to antibiotics and keep coming back after treatment. If this happens, your doctor may refer you to a specialist for further assessment and treatment. They may suggest a procedure called faecal microbiota transplantation (or donor stool transplantation). This involves taking an extract of poo from a healthy human donor, and placing it into your bowel in order to restore the normal, healthy bacteria.

Rarely, if you have other complications related to the infection, you may need surgery to remove part of your bowel (a colectomy). For more information on this, see our section: Complications of C. difficile below.

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Recovering from clostridium difficile infection

It normally takes a week or two for your diarrhoea to clear up once you’ve started treatment. You will be infectious while you still have symptoms (this means you can pass the infection to others). For advice on how to stop the spread of infection, see our section: Prevention of C. difficile infection below. You’ll usually be able to go back to work or school when you’ve been free from diarrhoea for 48 hours.

Complications of clostridium difficile infection

Most people who get C. difficile respond to the initial treatment and make a good recovery. But for people with more severe disease, there can be serious complications which can be life-threatening. These include severe dehydration, for which you’ll need to be treated in hospital.

Very rarely, a C. difficile infection can lead to a serious condition called toxic megacolon, where your bowel swells. There is a risk of your bowel perforating, causing blood poisoning. This can be fatal. Your doctor will check for signs of these complications, and you’ll be admitted to hospital if necessary to receive appropriate treatment. You may need to have surgery to remove part of your bowel.

Complications are more likely if you’re older, if you have any other health conditions and if you’re staying in hospital.

How is clostridium difficile infection spread?

C. difficile infection can spread easily from person to person through touching contaminated surfaces. For example, hospital staff, patients and visitors can become exposed to the bacteria by touching bed frames, toilets and taps contaminated by an infected person. The bacteria can live for a long time on these surfaces.

Once you have the bacteria in your body, even if you don’t develop an infection yourself, you can pass it on to other, more vulnerable people. This is why it’s important to thoroughly wash your hands when you enter and leave clinical areas in a hospital.

Prevention of clostridium difficile infection

If you’re infected with C. difficile or have been in contact with someone who has it, it’s important to take measures to prevent it spreading further.

If you have C. difficile, make sure you regularly wash your hands with soap and warm, running water. This is especially important after going to the toilet and before preparing or eating food. If you’re caring for someone with C. difficile, make sure you wash your hands properly after you’ve had contact with them or their immediate environment (bedrails etc). You should also regularly clean your kitchen and bathroom using disinfectant or household detergents containing chlorine. For more information, see our FAQ: How do I care for someone with C. difficile at home? below.

If you’re in hospital and have C. difficile infection, you’ll usually be moved to a single room or an area where other people have the infection. The hospital staff will follow strict hygiene rules to prevent spreading the C. difficile infection. Any visitors you have should wash their hands with soap and warm water before and after they visit you. Alcohol gels aren’t very effective at killing C. difficile, so they won’t prevent the infection.

Frequently asked questions

  • It’s much more common to become infected with C. difficile in a hospital or a similar environment, such as a nursing home. People are more vulnerable in these places because they’re often frail or have other illnesses. They’re also living in close contact with lots of other people, so if one person develops C. difficile infection, it can spread quickly to other vulnerable people.

    However, you can still get the infection outside these environments. Lots of people carry C. difficile bacteria in their bowel and you can become exposed to it through contact with someone who has the infection. If you’re healthy, being exposed to the bacteria doesn’t always mean you’ll develop an infection. But certain factors can increase your risk – for instance, if you’re older (usually over 65) or have other health problems. If the bacteria are already present in your body and you need to take a course of antibiotics, this will also put you at risk.

    If you develop diarrhoea along with other symptoms such as abdominal pain and cramps or a fever – always seek medical advice. This is especially important if you’ve been in contact with someone who has C. difficile.

  • It’s important to follow good hygiene measures in order to reduce the risk of C. difficile spreading to you or other members of your family. Even if you don’t develop the infection yourself, carrying the bacteria can put other people you come into contact with at risk. It also means the person you’re caring for may become re-infected after recovering from their original infection.

    One of the main ways the bacteria are transferred is by hands and through touching surfaces or other items they’ve been in contact with. Proper handwashing is the single most important thing you can do to prevent infection spreading.

    Good hygiene measures include the following.

    • All family members should wash their hands regularly using soap and warm water, especially after contact with the infected person and before preparing and eating food.
    • Don’t share towels, facecloths or other personal hygiene items with the infected person.
    • Regularly clean all surfaces that the infected person has come into contact with, including the bathroom with a hypochlorite disinfectant (bleach). Focus particularly on cleaning toilet seats, showers, baths, sinks, taps and handles using disinfectant.
    • Throw away any cleaning cloths you’ve used to clean surfaces, or wash them at 60°C or above.
    • Keep the sheets, pillows and clothes of the infected person separate from the rest of the family laundry and wash them at 60°C or above. Wash your hands after handling any soiled items.
    • Wear disposable gloves if you have to come into contact with the faeces (stool) of the infected person. And wash your hands after taking your gloves off.

    It’s also important when caring for someone with C. difficile is to make sure the infected person is getting enough to drink to keep them hydrated. Encourage them to drink plenty of fluids, including fruit juices and soups if they feel up to it. Once they’re starting to feel better, they can try small, light meals. Make sure these aren’t fatty or spicy. Dry toast can be a good thing to start with. If the person starts to feel worse at any point or their symptoms return, seek advice from your doctor.


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Related information

    • Clostridium difficile-associated disease. BMJ Best Practice. bestpractice.bmj.com, last reviewed May 2019
    • Clostridium difficile: infection and infection prevention through hygiene in the home. International Scientific Forum on Home Hygiene. www.ifh-homehygiene.org, last updated 2015
    • Diarrhoea – antibiotic associated. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2019
    • Clostridium difficile: guidance, data and analysis. Public Health England, last updated 9 March 2018. gov.uk
    • Clostridium difficile-induced diarrhoea. MSD Manual. www.msdmanuals.com, last full review/revision January 2018
    • Acute diarrhoea. Guts UK. gutscharity.org.uk, accessed 24 June 2019
    • Updated guidance on the diagnosis and reporting of Clostridium difficile. Department of Health, March 2012. gov.uk
    • Pseudomembranous colitis. PatientPlus. patient.info, last reviewed 23 March 2016
    • Updated guidance on the management and treatment of Clostridium difficile infection. Public Health England, May 2013. gov.uk
    • Faecal microbiota transplant for recurrent Clostridium difficile infection. National Institute for Health and Care Excellence (NICE), March 2014. www.nice.org.uk
    • Gastroenteritis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised March 2019
    • Personal communication, Professor Robert Read, Professor of Infectious Diseases, University Hospital Southampton, July 2019
  • Reviewed by Pippa Coulter, Freelance Health Editor, August 2019
    Expert reviewer, Professor Robert Read, Professor of Infectious Diseases, University Hospital Southampton
    Next review due August 2022



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