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Clostridium difficile infection


Expert reviewer, Professor Robert Read, Professor of Infectious Diseases, University Hospital Southampton
Next review due March 2020

Clostridium difficile is a type of bacteria that can infect your bowel and cause diarrhoea. Its name is usually shortened to C. difficile or sometimes, C. diff.

C. difficile infection most commonly affects people who’ve had a course of antibiotics in the recent past and are in hospital or long-term care homes. However, it can spread to others.

Further antibiotics are usually successful in treating C. difficile infection, although 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 in the environment, for instance in soil and water. Most young children and about three in 100 adults have C. difficile in their bowel without realising it. If you’re healthy, this doesn’t usually cause any problems because the growth of C. difficile is controlled by other types of bacteria in your body.

However, some antibiotics destroy the bacteria that usually prevent C. difficile from multiplying. If this happens, the number of C. difficile in your bowel can increase and cause symptoms of the infection.

Symptoms of clostridium difficile infection

Symptoms of C. difficile infection may include:

  • diarrhoea, which may be watery
  • abdominal (tummy) pain
  • a high temperature
  • blood in your faeces (stool)
  • loss of appetite
  • feeling sick

These symptoms may be caused by problems other than C. difficile infection. If you have any of these symptoms and have recently been treated with antibiotics (especially if you’re over 65), contact your GP. If you can, try not to visit your doctor’s surgery or hospital because you could easily pass the infection on to others.

Diagnosis of clostridium difficile infection

Because a number of different conditions can cause similar symptoms to those of C. difficile infection, it may be difficult for your doctor to diagnose. They may ask you for a sample of your faeces (stool). This will be sent to a laboratory for testing.

Treatment of clostridium difficile infection

If you have a mild C. difficile infection, the only treatment you may need is to stop taking antibiotics. You’ll also need to make sure you drink enough fluids to replace those that you’ll have lost as a result of having diarrhoea.

Don’t take any over-the-counter anti-diarrhoea medicines if you have diarrhoea caused by C. difficile. This is because they can slow down your diarrhoea and increase the time your colon (large bowel) is exposed to the toxins (poisons). This can make your colon more inflamed and increase the risk of damage.

If you become severely dehydrated, you may need to have fluids given to you through a drip in your arm.

If you have a more serious infection, your doctor may prescribe a different antibiotic to the one you’ve been taking. The antibiotics usually prescribed for C. difficile infection are called metronidazole and vancomycin. Another drug, fidaxomicin, is occasionally prescribed instead of vancomycin. You’ll need to take the antibiotics for at least 10 days. Make sure you finish your course of treatment, even if your symptoms clear up.

If you have recurring disease that is not responding to these drugs, your doctor may offer you a treatment called faecal microbiota transplant. This is increasingly being used in the UK for this kind of problem. In this treatment, a plastic tube will be passed through your nose and down the gullet, through the stomach and into your upper small bowel. Then, an extract of the faeces from a healthy human donor will be passed down the tube over the course of about 20 minutes. The donor will have been screened for infectious diseases.

You’ll usually be able to go back to work or school when you’ve been free from diarrhoea for 48 hours.

Even if the treatment gets rid of your infection, there’s a possibility that it can come back. 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 treatment.

Causes of clostridium difficile infection

C. difficile infection is usually caused by taking antibiotics for another illness. You’re more at risk of getting C. difficile infection if you’re taking broad spectrum antibiotics. These are antibiotics that are used against a variety of bacteria. However, they can also destroy the natural bacteria in your bowel, leading to the overgrowth of C. difficile.

C. difficile infection can spread easily from person to person via touching contaminated surfaces. For example, healthcare workers and those in hospital can spread the bacteria by touching a contaminated surface (such as furniture, toilets and taps). The bacteria can live for a long time on these surfaces.

Disease due to C. difficile becomes more likely as you get older. And you may be more likely to get C. difficile infection if you have a condition that weakens your immune system. For example, you may be receiving treatment for cancer or have HIV/AIDS.

Complications of clostridium difficile infection

If you have a severe infection with C. difficile then you may be at risk of severe dehydration. This can lead to serious problems such as low blood pressure and kidney failure.

Very rarely, a C. difficile infection can lead to your bowel perforating and blood poisoning, which can be fatal.

Prevention of clostridium difficile infection

It’s very important to stop the spread of C. difficile. Especially if you’re infected with it, or you’ve been in contact with someone who has it. You can do this by making sure you regularly wash your hands with soap and warm water. This is especially important after going to the toilet and before preparing or eating food.

You should also regularly clean your kitchen and bathroom using disinfectant or household detergents containing chlorine. See our FAQ below on caring for someone with C. difficile infection at home for more information.

If you’re in hospital and have C. difficile infection, you’ll usually be moved into a single room or to an area where other people also 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 won’t prevent the infection.

Frequently asked questions

  • Yes, there are different types of C. difficile bacteria. Some types can cause more serious symptoms than others.

    More information

    One type is called type 027 and has been identified as the cause of the most serious outbreaks of C. difficile infection. It’s more severe because it produces more of the toxins (poisons) that attack the cells in your bowel. It’s also able to spread very easily from person to person.

  • It’s much more common to become infected with C. difficile in a hospital or similar environment, such as a nursing home. However, you can still get it simply by being out and about within your community.

    C. difficile can be spread through the diarrhoea of infected people and passed to others through hand-to-hand contact. It can also spread through contact with contaminated objects such as bedpans, toilets or furniture surfaces.

    The spread of C. difficile infection is more likely to occur in hospitals, where people are unwell. Or in places such as nursing homes where there are many people in close contact with one another. This means that if one person develops C. difficile infection, it can spread quickly to other vulnerable people.

    Although it’s less likely, it’s still possible to get C. difficile infection if you’re not in hospital. If this happens, you’ll need to stay off work or school until you haven’t had diarrhoea for at least 48 hours.

    It’s also important to take steps to stop the infection spreading to others. You can do this by making sure you regularly wash your hands with soap and warm water. This is especially important to do after going to the toilet, and before preparing or eating food. See our FAQ below on caring for someone with C. difficile infection at home for more information.

  • Yes, if you’re already in hospital, you’ll need to stay there for treatment until 24 to 48 hours after your diarrhoea has stopped. This is because you could pass the C. difficile infection on to someone else.

    More information

    When you’re in hospital, it’s best that you stay in a separate room so that the infection doesn’t spread to other people. However, this isn’t always possible, so you may stay in a special area with other people who also have C. difficile infections. If you have any visitors, they’ll need to wash their hands with soap and water before they come into, and before they leave the ward.

  • 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. One of the main ways the bacteria are transferred is via hands and through touching surfaces or 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 using the toilet and before preparing and eating food. Be especially sure to wash your hands after contact with the infected person.
    • Regularly clean with disinfectant all surfaces that the infected person has come into contact with, including the bathroom. Focus particularly on cleaning toilet seats, showers, baths, sinks, taps and handles using disinfectant.
    • Don’t share towels, facecloths or other personal hygiene items with the infected person.
    • 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.

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Related information

  • Public Health England provides detailed technical information about the management of Clostridium difficile infections.

    You can find out more about preventing infection in the home from the International Scientific Forum on Home Hygiene.

    • Clostridium difficile: associated disease. BMJ Best practice. bestpractice.bmj.com, last updated 3 August 2016
    • Clostridium difficile colitis. Medscape. emedicine.medscape.com, updated 2 November 2016
    • Pseudomembranous colitis. PatientPlus. patient.info/patientplus, last checked 23 March 2016
    • Clostridium difficile-induced diarrhea (pseudomembranous colitis). The MSD Manuals. www.msdmanuals.com, last full review/revision January 2016
    • Diarrhoea – antibiotic associated. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2013
    • Faecal microbiota transplant for recurrent Clostridium difficile infection. National Institute for Health and Care Excellence (NICE), March 2014. www.nice.org.uk
    • Map of Medicine. Clostridium difficile. International View. London: Map of Medicine; 2014 (Issue 2)
    • Updated guidance on the management and treatment of Clostridium difficile infection. Public Health England, 2013. www.gov.uk
    • Clostridium difficile infection information for patients. CDC, Centers for Disease Control and Prevention. www.cdc.gov, accessed 8 March 2017
    • Clostridium difficile: infection and infection prevention through hygiene in the home. International Scientific Forum on Home Hygiene. www.ifh-homehygiene.org, last updated 2015
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, March 2017
    Expert reviewer, Professor Robert Read, Professor of Infectious Diseases, University Hospital Southampton
    Next review due March 2020



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