Clostridium Difficile (C. Diff) Infection

C. diff (Clostridium difficile) bacteria can be very harmful. They affect the intestinal tract. They can cause symptoms ranging from mild diarrhea to severe inflammation of the large intestine (colon). C. diff infection may also be called Clostridioides difficile infection. It's most common during the days and weeks after treatment with antibiotics. Anyone can get infected. But the risk is higher for people in hospitals and for people living in nursing homes or long-term care facilities. This is because antibiotic use is common there. Germs also spread easily in these places.

What causes C. diff infection?

The stomach and intestines have hundreds of kinds of bacteria. Many of these bacteria actually help keep harmful bacteria, such as C. diff, from causing problems. Small amounts of C. diff are normal in the intestine and don’t cause problems. When you take an antibiotic, the normal balance of good and bad bacteria may be affected. There may be too few of the good bacteria. This may allow the harmful bacteria, such as C diff, to grow. In hospitals and nursing homes, C. diff may be spread from an infected person to others. This can happen when staff or visitors touch infected people or objects (such as bed rails, stethoscopes, or bedpans) and then touch other people or surfaces.

What are the symptoms of C. diff infection?

People with a mild C. diff infection often have these symptoms:

• Watery diarrhea (3 or more times a day for several days)

• Stomach pain, soreness, and cramping

People with a severe C. diff infection may have symptoms that include:

• Severe stomach pain or soreness

• Frequent watery diarrhea (up to 15 times a day)

• Belly swelling

• Upset stomach (nausea) and vomiting

• Loss of appetite

• Blood or pus in their stool

• Fever

Sometimes people carry the C. diff germs but do not get sick. This is called colonization. Colonization is more common than C. diff infection and does not need treatment. People who are colonized have no symptoms. But they can still pass the infection to others.

How is C. diff infection diagnosed?

To confirm the infection, a stool sample is taken. It's tested for the bacteria or the toxins made by the bacteria.

How is C. diff infection treated?

In many cases, you will be given an antibiotic or other medicine or therapy directed at the C. diff infection. Your healthcare provider might advise that you stop taking or change the antibiotics you've been prescribed. Talk with your provider before stopping or starting any medicines.

• Fluids are often given by IV (intravenously) through a vein. This helps replace fluids lost through diarrhea.

• In rare cases, you may need surgery if treatment doesn’t cure severe symptoms.

To reduce symptoms:

• Drink plenty of fluids to replace water lost through diarrhea. Talk with your provider or nurse about which fluids are best.

• Follow your provider’s instructions for when and what to eat.

• Unless your provider tells you to do so, don't take medicines for diarrhea.

• Tell your provider if symptoms return. Even after treatment, C. diff may come back.

Your provider may give you an additional treatment if your symptoms come back. Or if you're not able to clear the C. diff infection with a standard course of treatment. This could include:

• A longer, decreasing course (called a taper) of treatment with the antibiotic vancomycin and metronidazole.

• A procedure (fecal transplant) in which normal fecal material is put into your intestines. This is done to give you the good bacteria again and stop the C diff infection from coming back.

• A medicine called bezlotoxumab. In some cases, it can help prevent your symptoms from returning.

What are possible complications of C. diff infection?

Complications include:

• Fluid loss (dehydration)

• Electrolyte imbalances

• Low protein in the blood

• Severe widening (dilation) and inflammation of the large intestine (toxic megacolon)

• A hole (perforation) in the bowel (often caused by toxic megacolon)

• Low blood pressure

• Kidney failure

• Inflammation or infection all over the body

• Death

How is C. diff prevented?

Hospitals and nursing homes take these steps to help prevent C. diff infections:

• Limiting use of antibiotics. Giving antibiotics only when needed can help reduce C. diff infections.

• Handwashing. Hospital staff should wash their hands before and after treating each person. They should also wash their hands after touching any surface in someone's room. Washing hands with soap and clean, running water for at least 20 seconds works better than alcohol-based hand cleaners for C. diff.

• Protective clothing. Healthcare workers should wear gloves and a gown when entering the room of someone with C. diff infection. They should remove these items before leaving and then wash their hands.

• Private rooms. People with C. diff should be in private rooms. This is to prevent the spread of infection.

• Thorough cleaning. Equipment and rooms should be cleaned and disinfected every day and deep-cleaned between each new person staying there.

• Education. Everyone should be shown the best ways to prevent infection.

You can do the following to help prevent C. diff:

• Take antibiotics only when you really need them. Antibiotics don’t help treat illnesses caused by viruses. This includes colds and the flu. Don’t ask for antibiotics from your healthcare provider if they say they won’t work.

• When you're given antibiotics, take them as directed. Don’t take more or less than the dosage prescribed. Unless otherwise instructed, finish the entire prescription even if you feel better.

• Wash your hands carefully. Do this after using the bathroom and before eating. Use plenty of soap and clean, running water. And wash for at least 20 seconds. Alcohol-based hand cleaners may not work against C. diff germs.

• Teach children correct handwashing. Show them good handwashing methods in all situations.

In a hospital or care facility

When visiting someone who has C. diff infection:

• Wash your hands well. Wash your hands before and after visiting the person. Use soap and water. Alcohol-based hand cleaners may not work against C. diff. They're not advised after contact with someone with C diff.

• If the staff asks you to, wear gloves. Take any other steps you're asked to follow to help prevent infection.

Caring for someone with C. diff infection

Take these steps when caring for someone who has C. diff infection:

• If instructed, wear gloves when caring for the person. Throw the gloves away after each use. Then wash your hands well.

• Wash the person’s clothes, bed linens, and towels separately. Use hot water. Use both detergent and liquid bleach.

• Disinfect surfaces in the person’s room. This includes the phone, light switches, and remote controls.

Practice good handwashing

• Use clean, running water and plenty of soap. Rub your hands together well.

• Clean your whole hand. Wash under nails, between fingers, and up your wrists.

• Wash for at least 15 to 20 seconds. 

• Rinse. Let the water run down your fingers, not up your wrists.

• Dry your hands well with disposable paper towels. Then use a paper towel to turn off the faucet and open the door.