C. diff: what you need to know

The bacterium Clostridioides difficile, commonly known as C. diff, is believed to cause nearly half a million infections each year in the United States, according to the Centers for Disease Control and Prevention (CDC). Many of those infected become seriously ill, and for some people, it can turn deadly.

C. diff is spread largely in the hospital or other healthcare settings, though infection rates in hospitals and rehabilitation facilities have dropped greatly in recent years. C. diff can be passed on in other places, too. More than half of C. diff cases in 2020 were community-associated, meaning people became infected outside of hospitals or inpatient medical facilities, according to a 2023 review in the journal Antibiotics.

Here’s how you can take steps to protect yourself and your community.

What is C. diff?

C. diff is a type of bacterium that is found in feces (poop) and lives in the intestines of many people. It’s usually harmless, kept in check by other, “good” intestinal bacteria. But when that balance is disrupted, C. diff produces toxins that damage the lining of the colon, causing a range of medical problems, from inflammation to potentially deadly diarrhea.

One of the main contributors to C. diff infection is the use of antibiotics. Antibiotics not only kill off the germs that make you sick, they’re strong enough to kill some of the intestinal bacteria that keep C. diff under control.

What are the symptoms?

Symptoms of C. diff infection range from mild to severe. Signs of a mild case may include:

• Watery diarrhea three times or more in a day
• Cramping in the abdomen (belly)
• Abdominal tenderness

A more severe reaction may include:

• Watery diarrhea 10 to 15 times each day
• Fever
• Persistent (constant) abdominal pain
• Swollen abdomen
• Loss of appetite
• Nausea
• Fast heart rate
• Blood in the stool (poop)

Who is at risk?

Anyone can get a C. diff infection, even if they have no risk factors. Taking a course of antibiotics increases your risk of being infected, both during treatment and for about a month after it’s completed.

Additional risk factors for C. diff infection or for developing a more severe case may include:

• Being age 65 or older
• Taking antibiotics for more than a week
• A recent stay in a hospital or nursing home facility
• Having a weakened immune system
• Having already had C. diff

There are additional concerns about the rise of C. diff in children. A 2023 review in Pediatrics noted that 20,000 children develop C. diff infections each year in the U.S. Most of these cases are community-associated.

How does C. diff spread?

The bacteria live—and are shed—in the feces of people who are infected. In hospital settings, that means toilets, bathroom fixtures, bed linens, and medical equipment are common hot spots for C. diff spores. Making matters worse, the bacteria can live on surfaces for months when they’re not disinfected properly. Hospital workers who touch these surfaces can transmit C. diff to patients for whom they are caring.

People can also infect themselves or others by touching a contaminated object or shaking the hand of someone who has been contaminated and then putting their hand to their mouth or nose, giving C. diff an easy entry point.

How is C. diff treated?

If you’re taking an antibiotic for a separate infection when you’re diagnosed with a C. diff infection, your healthcare provider (HCP) may ask you to stop taking it. This may be enough for your body to recover. More serious cases may be treated with antibiotics such as vancomycin or fidaxomicin, which are known to be effective against disease.

Symptoms of mild infections usually start easing up within a few days with treatment. People with severe cases may need to be admitted to intensive care or have emergency surgery. About 1 in 9 people have recurrences of C. diff infections according to the CDC, which means they relapse between two and eight weeks of treatment and may require additional rounds of antibiotics.

Fecal microbiota therapy is another potential treatment. This involves introducing a healthy donor’s medically processed feces to someone for whom repeat antibiotics haven’t worked. Treatments are available via oral capsule, rectal enema, colonoscopy, or nasal tube.

An HCP may also recommend probiotics to help build your good gut bacteria back up.

How can I avoid getting C. diff?

Because the bug is a hardy one, it’s important to practice good hygiene, especially after a visit to an HCP’s office or other healthcare facility. Be sure to:

• Wash your hands regularly with soap and water. Don’t rely exclusively on alcohol-based hand sanitizers to do the job.
• Ensure that all surfaces, from doorknobs to mobile phones to keyboards, are cleaned with bleach-based products if you think an infected person has touched them.
• Make sure to clean any laundry of a sick person—including bed linens, towels, and clothing—in hot water. Use chlorine bleach if possible.

Finally, since overuse and misuse of antibiotics play major roles in C. diff antibiotic resistance, discuss their use with your HCP. If you do take antibiotics, make sure you take them exactly as prescribed. Stopping them too soon or skipping a dose may alter the microorganisms in your gut, ultimately doing more harm than good.