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What Is C. diff? Symptoms, Causes, and Treatments Explained

What Is C. diff? Symptoms, Causes, and Treatments Explained
Key Takeaways
  • Clostridioides difficile (C. diff) is a bacterium that infects the colon (large intestine) in humans, causing a wide range of symptoms from severe diarrhea to life-threatening complications. This illness frequently occurs during or after taking antibiotics. 

  • People who have had C. difficile are at risk of getting it again. Other risk factors include taking antibiotics, age above 65 years, weakened immune system, underlying health conditions, prior surgical procedures on the stomach area, and recent hospitalization or nursing home stay. 

Clostridioides difficile is a bacterium that infects the colon (large intestine) in humans. Other names for this bacterium are C. difficile and C. diff

C. diff bacteria can cause severe diarrhea. This illness frequently occurs during or after taking antibiotics. Older adults and people in healthcare settings are more likely to develop C. diff infections.

The Centers for Disease Control and Prevention (CDC) estimates that C. diff causes almost half a million infections in the United States each year. About 1 in 6 people who get C. diff go on to develop a repeat infection in the next 2 to 8 weeks. Also, 1 in 11 people over the age of 65 diagnosed with C. diff in a hospital or nursing home die within one month.

What is the Main Cause of C. diff?

The cause of C. diff is the Clostridioides difficile bacterium. This is a spore-forming, Gram-positive, anaerobic bacterium. C. diff produces toxins in the colon (large intestine). It is a significant cause of antibiotic-associated colitis (inflammation of the colon). 

Worldwide, C. difficile infections are among the most common infections in healthcare settings because, in these places, the bacterium can be easily transmitted between patients. 

Risk Factors for C. difficile

The most significant risk factor for a Clostridioides difficile infection is taking antibiotics recently, especially over a long period of time. This is because antibiotic therapy not only kills bad germs that have caused an infection but also good or helpful bacteria in the gut (gut microbiota). When there aren’t enough healthy bacteria in the gut, C. difficile can grow out of control. 

All kinds of antibiotics can cause C. difficile infections, including penicillins, cephalosporins, clindamycin, and fluoroquinolones. Antibiotic treatment for more than a week increases the risk. Also, using antibiotics when they are not needed significantly increases the risk of C. difficile infections. For example, using antibiotics for a viral or fungal infection will increase the risk of C. diff, making it more challenging to treat an infection later. 

Other known risk factors for C. difficile infections are healthcare settings, such as hospitals, long-term care facilities, and nursing homes. These are places where antibiotic use is common, and germs can spread easily. 

As noted above, the use of antibiotics and inadequate infection control in healthcare settings are the two major risk factors for C. diff infections. However, C. difficile infections can also occur without antibiotic use and outside hospitals and care settings. Some strains of the bacteria that can cause serious infections are more likely to infect younger people. 

Other risk factors include:

  • Age above 65 years

  • A weakened immune system, such as organ transplant patients and those with HIV/AIDS 

  • Underlying health conditions

  • Prior surgical procedures on the digestive tract or stomach area

  • Prior C. difficile infection

  • Taking certain medications, such as proton pump inhibitors used to treat excess stomach acid

  • Recent hospitalization or prolonged hospital stay

Repeat C. diff Infections

People who have had C. difficile are at risk of getting it again. This may be because the original infection was not cleared completely or because of a completely new C. diff infection. The risk increases with each subsequent infection. People who have had three or more C. difficile infections have a more than 50% risk of having another one. 

Risk factors for repeat C. diff infections include:

Symptoms of C. diff

Common Symptoms 

The symptoms of C. diff usually start 5-10 days after starting antibiotic therapy. However, C. diff can occur anywhere from 1 day to 3 months after taking antibiotics.

The most common symptoms of a mild to moderate C. diff infection are watery stools three or more times a day, lasting for more than a day. They are typically accompanied by stomach cramps and discomfort. 

Severe Symptoms

Severe C. difficile infections can cause dehydration due to loss of fluids from diarrhea up to 10-15 times a day. Symptoms of a severe infection include:

  • Watery diarrhea 

  • Severe stomach cramps

  • Rapid heartbeat

  • Fever

  • Nausea

  • Bloating 

  • Loss of appetite

  • Weight loss

  • Blood or pus in stool

How to Recognize C. diff and When to See a Doctor

If you develop watery diarrhea after taking antibiotics, it could be C. diff. Call your doctor without delay if you have:

  • Watery diarrhea 3 or more times a day

  • Symptoms lasting 2 or more days

  • New fever

  • Severe stomach pain or stomach cramps

  • Blood in stool

Common Complications of C. diff Infections

The frequent bouts of watery diarrhea can lead to life-threatening dehydration and other serious complications like kidney failure. Some people with C. difficile develop pseudomembranous colitis, a life-threatening inflammation of the large intestine. 

Rarely, people with a sudden, severe C. difficile infection develop toxic megacolon (a condition in which the colon becomes enlarged and inflamed). 

Other complications include bowel perforation and peritonitis due to bacteria spilling into the abdominal cavity through a hole in the colon. A severe C. diff infection can also lead to sepsis, where the immune system becomes overwhelmed by the infection and attacks its own tissues. Patients who develop C. diff complications such as toxic megacolon or sepsis require care in an intensive care unit. Severe C. difficile infections can be fatal.

Transmission and Prevention

How is C. diff Transmitted?

C. diff germs are mainly transmitted from feces (stool) to the mouth. After the bacteria enter the body through the mouth, they start multiplying in the small intestine. When they reach the colon (large intestine), they release toxins and cause damage, resulting in severe diarrhea. 

In health care settings, the spores of C. diff bacteria can be transmitted via contaminated surfaces and medical equipment if proper infection control and cleaning protocols are not followed. C. diff can be present on cart handles, bed rails, toilet bowls, sinks, telephones, remote controls, thermometers, stethoscopes, and other tools and equipment. Spores can survive for months on these surfaces and are resistant to many types of disinfectants.

C. difficile bacteria are not active outside the human colon, but they can survive for a long time in soil, feces, food, water, unwashed hands, and contaminated surfaces and equipment. If the bacteria find their way into a person’s digestive tract, they can become active again and cause a C. diff infection. That’s why it is easier for C. diff to spread in hospitals and other healthcare settings.

Note: Some people are carriers of C. diff, meaning they carry the bacteria in their intestines but do not get sick. Carriers can spread the infection to others.

Preventive Measures in Healthcare Settings

To lower the risk of Clostridioides difficile infections, you should only take antibiotics when they are prescribed by a healthcare provider. Antibiotics treat bacterial infections. They are not effective for viral illnesses. Using antibiotics when they are not needed increases the risk of C. diff infections. 

If you need to take an antibiotic, talk to your healthcare providers about taking a narrow spectrum antibiotic. These antibiotics act against a limited number of bacteria. In contrast, broad spectrum antibiotics are effective against a wide range of bacteria and are more likely to eliminate helpful bacteria in the gut, leading to overgrowth of C. diff bacteria. 

Is It Okay To Be Around Someone With a C. diff Infection?

It is okay to be around someone with a C. diff infection, provided you take precautions. People diagnosed with a Clostridioides difficile infection in hospital are put in a private room or share a room with someone who also has C. diff. Healthcare workers and visitors are required to wear personal protective equipment (disposable gloves and gowns) while in the room. All surfaces in the room are thoroughly disinfected with chlorine bleach (C. diff bacteria are not killed by non-bleach cleaning products).

Preventive Measures for Caregivers and Patients

To prevent the spread of healthcare-associated C. difficile, follow the hygiene measures, instructions, and rules for infection control. This includes washing your hands frequently with soap and warm water. (Clostridioides difficile spores are not destroyed by alcohol-based hand sanitizers).

Diagnosis and Treatment Options

Diagnostic Tests for C. difficile

Clostridioides difficile infection is diagnosed if you have diarrhea and other symptoms of C. difficile and C. difficile bacteria or toxins are detected on a stool test. Your doctor may also do a lab test such as a complete blood count. People with C. diff infection often have elevated white blood cells.

Imaging tests such as X-rays and CT scan are sometimes done to detect complications of a C. diff infection, such as an enlarged colon, thickened bowel wall, or bowel perforation. In rare cases, health care providers may do a flexible sigmoidoscopy or colonoscopy to take a look inside the colon. 

Does C. diff Go Away On Its Own?

C. diff can go away on its own. The watery diarrhea often goes away quickly and completely. Most people don’t develop C. diff complications. However, in severe cases, a C. diff infection can quickly become serious, especially in certain high-risk individuals. That’s why you should always call your doctor if you develop diarrhea after antibiotic treatment. 

Common Treatments for C. diff

Only people with symptoms of Clostridioides difficile are treated. Carriers (people who don’t get sick) don’t require any treatment. 

If an antibiotic has caused a C. difficile infection, your doctor will advise you to stop taking the antibiotic. However, if you need to take an antibiotic to treat another infection, your provider will prescribe a different antibiotic that is less likely to cause C. difficile.

The Clostridioides difficile infection itself is also treated with antibiotics. The most common ones are vancomycin (Firvanq Kit) and fidaxomicin (Dificid). Serious C. difficile infections may need to be treated with other medicines like metronidazole (Flagyl) in addition to vancomycin. 

Surgery for C. diff Infections

Emergency surgery may be necessary to remove a damaged portion of the colon. For example, if there is severe inflammation around the stomach, organ failure, or toxic megacolon. 

Treatment for Repeat C. difficile Infections

People in whom C. difficile infections keep coming back are treated with the following: 

  • Antibiotics that are different from the ones used before. Unfortunately, antibiotic treatment becomes less effective with each subsequent C. diff infection. 

  • Antibody-based therapy with bezlotoxumab (Zinplava). This is a human antibody that is effective against toxin B produced by C. difficile bacteria. It can lower the risk of repeat infections. 

  • Probiotics are foods or supplements that contain good bacteria. It is not clear if they are helpful in treating or preventing Clostridioides difficile. Probiotics for C. diff are still being investigated for safety and efficacy.

Alternative and Emerging Treatments: Fecal Microbiota Transplants

A fecal microbiota transplant (FMT) is also called a stool transplant or intestinal microbiota transplant. It is a relatively new treatment that may be recommended for people who develop many infections with C. diff. Clinical trials have been done on FMT and have been shown to be effective. 

FMT involves placing stool from another person (a healthy donor) into your colon through special tubes inserted through the rectum. The stool is obtained from a donor after screening them for medical conditions, including infectious diseases. 

The goal of FMT is to reintroduce good germs from the donor’s stool into your gut. Research shows that one or more FMTs have an 85% success rate for treating repeat Clostridioides difficile infections.

Notably, the U.S. Food and Drug Administration (FDA) has approved the first oral fecal microbiota product in 2023. Vowst (SER-109) is approved for the prevention of the recurrence of C. diff infection in people 18 years and older. 

Prior to that, Rebyota (RBX2660) was approved in 2022; it is a fecal microbiota administered rectally to prevent the recurrence of C. diff