Clostridioides difficile — commonly known as C. difficile or C. diff — is a bacterium that causes diarrhea and colitis (inflammation of the colon). It’s typically found in feces and can easily contaminate food and surfaces.
Many people develop it while they’re hospitalized for surgery or receiving care for other illnesses. C. diff infection most commonly affects older adults in hospitals or in long-term care facilities and usually results from the use of antibiotics. But research suggests rates of C. diff infection are increasing, and cases are being diagnosed in young, healthy individuals who haven’t used antibiotics and who haven’t been in a healthcare facility.
Signs and Symptoms of C. Diff
- Watery diarrhea three or more times per day for two or more days
- Fever above 100.4 degrees F (38 degrees C)
- Loss of appetite
- Abdominal pain and cramps
In severe cases, C. diff infection may cause:
- Watery diarrhea up to 15 times per day
- Swollen abdomen, with severe cramping and pain
- Elevated heart rate
- Stool containing blood or pus
- Loss of appetite or weight loss
- Liver or kidney failure
- Increased white blood cell count
Causes and Risk Factors for C. Diff
What’s more, this bacterium produces spores that can persist in the environment for a long time.
Yet in people with weakened immune systems or recent antibiotic use, for example, C. diff can lead to illness from the release of toxins that attack the lining of the organ.
Although people with no known risk factors can get a C. diff infection, certain things increase your risk, including the heavy use of antibiotics for the treatment of long-term infections. These antibiotics can disrupt the normal makeup of the gut microbiome — the community of microbes living in the intestines — allowing C. diff to grow out of control and cause an infection.
- clindamycin (Cleocin HCL)
- ampicillin (Omnipen), amoxicillin (Amoxil), and other penicillins
In addition, the use of proton pump inhibitors (PPIs), a type of medicine that reduces stomach acid and treats acid reflux, also may increase your risk of C. diff infection.
How Is C. Diff Diagnosed?
- A stool test
- A blood test
- A computed tomography (CT) scan
- A colonoscopy or sigmoidoscopy procedure with a gastroenterologist (which is more involved than simple tests or scans)
A stool test is the most common way to detect C. diff. A pathologist assesses a sample of your stool to determine whether it contains C. diff bacteria.
Blood tests can reveal high levels of white blood cells, a sign of infection, including C. diff.
A colonoscopy allows your doctor to assess the entire colon and rectum, while a sigmoidoscopy provides images of the rectum and the lower part of the colon. Both tests can indicate whether inflammation is present, a telltale sign of a C. diff infection, among other infections or inflammatory disorders. They also allow your doctor to collect tissue samples from your colon, if needed, to further test them for bacteria.
Prognosis of C. Diff
Some C. diff infections can become fatal in certain patients if not treated promptly, because of severe dehydration or damage to the colon or intestines.
Most recurrences happen one to three weeks after a person stops taking antibiotics, but some occur two to three months later.
You are at higher risk for recurrence if:
- You’re older than 65
- You’re taking antibiotics for another condition while being treated with antibiotics for C. diff
- You have a severe underlying medical condition, including chronic kidney failure, inflammatory bowel disease, or chronic liver disease
Duration of C. Diff
Treatment and Medication Options for C. Diff
Depending on the severity of your infection, treatment for C. diff may include:
- Antibiotics (different antibiotics from the ones that triggered the C. diff)
- Chronic, recurrent C. diff–infected patients may pursue a new treatment called fecal transplant
Medication Options for C. Diff
While it may sound counterintuitive (since antibiotics cause C. diff), the initial treatment for an infection usually requires taking one of three antibiotics that remain effective against the bacteria. These drugs include, yet are not limited to:
- vancomycin (Firvanq)
- fidaxomicin (Dificid)
- metronidazole (Flagyl)
Oral vancomycin is typically the first-line antibiotic for the treatment of C. diff, while fidaxomicin (which can be cost-prohibitive) may be reserved for those with severe symptoms.
Metronidazole is now recommended when access to vancomycin and fidaxomicin is limited.
Surgery for C. Diff
For people who have severe pain, organ failure, toxic megacolon, or inflammation of the lining of the abdominal wall, surgery to remove the affected portion of the colon may be the only option.
In people with recurrent C. diff, despite medication management, a fecal microbiota transplant (FMT) may be an option. In this procedure, the stool of a healthy person is transplanted into the colon of a person with C. diff infection.
Alternative and Complementary Therapies for C. Diff
There’s some evidence that using probiotics while taking certain antibiotics may help prevent C. diff infections.
Talk to your doctor before using probiotics or any other OTC products to treat your C. diff.
Prevention of C. Diff
- Take your C. diff medication exactly as instructed by your doctor
- Wash your hands with soap and water after going to the bathroom, before preparing or eating food, and when they’re dirty — and encourage family to do the same
- Clean bathroom and kitchen surfaces regularly with household detergents or disinfectants
- Tell your doctor right away if your diarrhea returns after treatment
Complications of C. Diff
- Dehydration (which can lead to kidney failure, if extreme)
- Toxic megacolon
The severe diarrhea caused by C. diff can lead to a significant loss of fluids and electrolytes, making it difficult for your body to function normally. In turn, this can cause blood pressure to drop to dangerously low levels.
In some cases of C. diff infection, dehydration occurs so rapidly that kidney function deteriorates, leading to kidney failure.
In addition, toxic megacolon is a rare condition that can develop after C. diff infection. If your colon is unable to expel gas and stool, it can become greatly distended, potentially causing it to rupture and allow bacteria to seep into your abdominal cavity (a condition called peritonitis).
Toxic megacolon requires emergency surgery and can be fatal if left untreated. A bowel perforation, or hole in your large intestine, is a rare complication that results from extensive damage to the lining of the organ following toxic megacolon.
Research and Statistics: Who Has C. Diff?
Related Conditions and Causes of C. Diff
The bacteria that cause C. diff have, at least to date, not been linked with other health conditions. But C. diff’s symptoms may mimic those of other conditions, including:
- Traveler’s diarrhea
Unlike C. diff, traveler’s diarrhea is rarely life-threatening, but it can be unpleasant.
Dehydration also causes dry mouth, fatigue, dizziness, headache, and muscle cramps. You may also urinate less often than you normally do or have dark urine. Most cases of dehydration are mild, and resolved by drinking lots of fluids. But severe cases may require intravenous fluids administered by a health professional.
Finally, cholera is a bacterial intestinal infection that spreads through contaminated water, particularly in regions with poor sanitation. Like C. diff, it can also cause severe diarrhea and dehydration.
Resources We Love
The CDC, a trusted source for Everyday Health editors, has a comprehensive online section on C. diff, with the most current info, from treatment and prevention to life after C. diff.
For clear, up-to-date, and detailed coverage of C. diff, visit the Mayo Clinic’s website. You can also look into participating in the clinical trials they’re conducting, which investigate new treatments and interventions for C. diff.
This volunteer, nonprofit advocacy organization raises awareness about C. diff and provides resources for those who have the infection and those who’ve survived it, including nutritional tips and a TeleSupport program.
APIC is an association for healthcare professionals that aims to prevent the spread of infection, in particular healthcare-associated infections like C. diff. Their website offers in-depth info for providers and public health workers but also has resources for patients.
Additional reporting by Brian P. Dunleavy.