Clostridium difficile (klos-TRID-e-um dif-uh-SEEL), also known as Clostridioides difficile and often referred to as C. difficile or C. diff, is a bacterium that can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon.
Illness from C. difficile most commonly affects older adults in hospitals or in long-term care facilities and typically occurs after use of antibiotic medications. However, studies show increasing rates of C. difficile infection among people traditionally not considered to be at high risk, such as young and healthy individuals who haven't used antibiotics and who haven't been in a health care facility.
Each year in the United States, about a half million people get sick from C. difficile, and in recent years, C. difficile infections have become more frequent, severe and difficult to treat. Recurrent C. difficile infections also are on the rise.
C. difficile infection care at Mayo Clinic
Some people carry the bacterium C. difficile in their intestines but never become sick, though rarely may still spread the infection. Signs and symptoms usually develop within five to 10 days after starting a course of antibiotics, but may occur as soon as the first day or up to two months later.
Mild to moderate infection
The most common signs and symptoms of mild to moderate C. difficile infection are:
- Watery diarrhea three or more times a day for two or more days
- Mild abdominal cramping and tenderness
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:
- Watery diarrhea 10 to 15 times a day
- Abdominal cramping and pain, which may be severe
- Rapid heart rate
- Blood or pus in the stool
- Loss of appetite
- Weight loss
- Swollen abdomen
- Kidney failure
- Increased white blood cell count
Severe C. difficile infection may also cause severe intestinal inflammation, enlargement of the colon (also called toxic megacolon) and sepsis. People who have these conditions are often admitted to the intensive care unit.
When to see a doctor
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:
- Three or more watery stools a day
- Symptoms lasting more than two days
- A new fever
- Severe abdominal pain or cramping
- Blood in your stool
C. difficile bacteria are found throughout the environment — in soil, air, water, human and animal feces, and food products, such as processed meats. A small number of healthy people naturally carry the bacteria in their large intestines and don't have ill effects from the infection.
Spores from C. difficile bacteria are passed in feces and spread to food, surfaces and objects when people who are infected don't wash their hands thoroughly. These spores can persist in a room for weeks or months. If you touch a surface contaminated with C. difficile spores, you may then unknowingly swallow the bacteria.
Once established, C. difficile can produce toxins that attack the lining of the intestine. The toxins destroy cells, produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon, and cause watery diarrhea.
Emergence of a new strain
An aggressive strain of C. difficile has emerged that produces far more toxins than other strains do. The new strain may be more resistant to certain medications and has shown up in people who haven't been in the hospital or taken antibiotics. This strain of C. difficile has caused several outbreaks of illness since 2000.
Although people who have no known risk factors have gotten sick from C. difficile, certain factors increase the risk.
Taking antibiotics or other medications
Your intestines contain about 100 trillion bacterial cells and up to 2,000 different kinds of bacteria, many of which help protect your body from infection. When you take an antibiotic to treat an infection, these drugs tend to destroy some of the normal, helpful bacteria in addition to the bacteria causing the infection. Without enough healthy bacteria to keep it in check, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include:
Proton pump inhibitors, a type of medicine used to reduce stomach acid, also may increase your risk of C. difficile infection.
Staying in a health care facility
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 mainly on hands from person to person, but also on cart handles, bedrails, bedside tables, toilets, sinks, stethoscopes, thermometers — and even telephones and remote controls.
Having a serious illness or medical procedure
If you have a serious illness, such as inflammatory bowel disease or colorectal cancer, or a weakened immune system as a result of a medical condition or treatment (such as chemotherapy), you're more susceptible to a C. difficile infection. Your risk of C. difficile infection is also greater if you've had abdominal surgery or a gastrointestinal procedure.
Other risk factors
Women are more likely than men to have C. difficile infection.
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.
Complications of C. difficile infections include:
- Dehydration. Severe diarrhea can lead to a significant loss of fluids and electrolytes. This makes it difficult for your body to function normally and can cause blood pressure to drop to dangerously low levels.
- Kidney failure. In some cases, dehydration can occur so quickly that kidney function rapidly deteriorates (kidney failure).
- Toxic megacolon. In this rare condition, your colon is unable to expel gas and stool, causing it to become greatly distended (megacolon). Left untreated, your colon may rupture, causing bacteria from the colon to enter your abdominal cavity. An enlarged or ruptured colon requires emergency surgery and may be fatal.
- A hole in your large intestine (bowel perforation). This is rare and results from extensive damage to the lining of your large intestine or after toxic megacolon. A perforated bowel can spill bacteria from the intestine into your abdominal cavity, leading to a life-threatening infection (peritonitis).
- Death. Even mild to moderate C. difficile infections can quickly progress to fatal disease if not treated promptly.
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, don't be afraid to remind caregivers to follow the recommended precautions.
Preventive measures include:
- Avoid unnecessary use of antibiotics. Antibiotics are sometimes prescribed for viral illnesses that aren't helped by these drugs. Take a wait-and-see approach with simple illnesses. If you do need an antibiotic, ask your doctor to prescribe one that has a narrow range and that you take for the shortest time possible.
- Hand-washing. Health care workers should practice good hand hygiene before and after treating each person in their care. In the event of a C. difficile outbreak, using soap and warm water is a better choice for hand hygiene, because alcohol-based hand sanitizers don't effectively destroy C. difficile spores. Visitors also should wash their hands with soap and warm water before and after leaving the room or using the bathroom.
- Contact precautions. People who are hospitalized with C. difficile have a private room or share a room with someone who has the same illness. Hospital staff and visitors wear disposable gloves and isolation gowns while in the room.
- Thorough cleaning. In any health care setting, all surfaces should be carefully disinfected with a product that contains chlorine bleach. C. difficile spores can survive exposure to routine cleaning products that don't contain bleach.