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Clostridioides (Clostridium) difficile Infection

C diff Infection

Definition

Clostridioides difficile (C diff) is an infection of the intestine caused by bacteria.

Causes

The infection is caused by the C diff bacterium. It makes toxins as it grows. This bothers the lining of the intestine.

The intestines have a healthy balance of bacteria that help with digestion. Antibiotics can disturb this balance by killing some bacteria which lets others grow in their place. C diff may be able to grow after certain antibiotics.

The infection can also spread:

  • From direct contact with an infected person
  • By touching surfaces with the spores of the bacteria and then touching your mouth

Risk Factors

This problem is more common in older adults. Other things that may raise the risk are:

  • Recent antibiotic use
  • Weakened immune system
  • Recent hospital stay
  • Having intestinal diseases
  • History of prior C diff infection
  • Use of proton pump inhibitors

Symptoms

Problems range from mild to severe and may be:

  • Watery diarrhea
  • Belly pain or cramps
  • Bloating
  • Fever
  • Lack of hunger

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done.

Common tests are:

  • Stool tests to look for signs of the bacterium and its toxins
  • Blood tests to look for signs of infection

Rarely, the intestine may need to be viewed to look for changes. This can be done with an endoscopy.

Treatment

People who have C diff but do not have symptoms do not need to be treated.

The goal of treating people who do have symptoms is to treat the infection. Choices are:

  • Stopping or changing antibiotics that may have caused the infection
  • Using specific antibiotics to treat the infection
  • A fecal microbiota transplant (FMT) to place stool from a healthy donor into a person's intestines to restore a healthy balance of bacteria
  • Surgery, such as:
    • Partial colectomy—The affected part of the colon is removed. The 2 healthy ends are joined.
    • Illeostomy with irrigation—The small intestine is brought through the abdominal wall to allow stool to leave the body. A liquid is used to flush the colon.

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Prevention

Proper hand washing is the best way to lower the risk of this problem. Other ways are:

  • Using antibiotics as advised
  • Cleaning surfaces
  • Using probiotics from food or supplements
RESOURCES:

Centers for Disease Control and Prevention
https://www.cdc.gov

Infectious Diseases Society of America
http://www.idsociety.org

CANADIAN RESOURCES:

Canadian Association of Gastroenterology
https://www.cag-acg.org

Public Health Agency of Canada
https://www.canada.ca/home.html

REFERENCES:

Clostridium difficile infection. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/clostridioides-clostridium-difficile-infection-in-adults-19. Accessed January 29, 2021.

Clostridium difficile infection information for patients. Centers for Disease Control and Prevention website Available at: https://www.cdc.gov/hai/organisms/cdiff/cdiff-patient.html. Accessed January 29, 2021.

C. difficile care at home. C Diff Foundation website. Available at: https://cdifffoundation.org/2014/08/14/c-difficile-care-at-home. Accessed January 29, 2021.

McDonald LC, Gerding DN, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018 Mar 19;66(7):e1.

C difficile-a rose by any other name... Lancet Infect Dis. 2019 May;19(5)449. Available at www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30177-X/fulltext?rss=yes. Accessed January 29, 2021.

Last reviewed September 2020 by EBSCO Medical Review Board David L. Horn, MD, FACP  Last Updated: 4/20/2021