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Clostridium Difficile or C. Difficile Infection: Causes, Symptoms, Treatment

What is Clostridium Difficile?

Clostridium difficile is also known as C. diff or C. difficile infection. This is bacterial infection that affects the colon and the symptoms are usually colon inflammation that is life threatening and diarrhea.

Adults in hospitals or those in facilities that offer long term care are often the most affected with clostridium difficile or c. difficile infection. This condition often occurs after medication that involves use of antibiotics. People who were previously considered not be at high risk of contracting clostridium difficileare now getting infected according to research. Examples are individuals who have not had previous health facilities exposure and also healthy and younger individuals.

More than 500,000 thousand people get infected with clostridium difficile or c. difficile infection annually. It has proved to harder to treat the infection of clostridium difficile in previous years. It has been more severe also.

Clostridium Difficile

What Causes Clostridium Difficile or C. Difficile Infection?

The bacteria of clostridium difficile or c. difficile infection are passed in feces, and spread to objects and surfaces when infected persons fail to clean their hands thoroughly. The spores produced by the bacteria can live inside a room for months or a couple of weeks. You may swallow the bacteria without knowing if you touch the surface that is contaminated by clostridium difficile.

Millions of bacteria are contained in the intestine which acts as the defense mechanism for your body from being infected. Some of the normal bacteria can be destroyed by antibiotics when you take some in order to treat an infection. The bacteria that cause the illness will also be destroyed. Clostridium difficile or C. difficile infection can get out of control if there are less healthy and normal bacteria. There are particular antibiotics that escalate the probability of being infected with clostridium difficile. Penicillins, clindamycin, cephalosprins, and fluoroquinolones are example of such antibiotics.

Once clostridium difficile has established itself in the intestines it will produce toxins that will be attacking the intestine’s lining. Watery diarrhea will be caused by the cellular debris which is produced in the colon. This is due to the fact the toxin produced will destroy cells and as a result produce plaques/patches of cells that are inflammatory.

What are the Symptoms of Clostridium Difficile or C. Difficile Infection?

Some people will never be sick despite the fact that they are carrying bacteria clostridium of difficile or c. difficile infection in their intestines. Nevertheless they can spread the infection.

The symptoms that are common for moderate to mild clostridium difficile or c. difficile infection infections are always:

  • Diarrhea that is watery for two or more days. This condition will be thrice or more times daily.
  • Mild tenderness or cramping of the abdomen.

Severe Clostridium Difficile or C. Difficile Infection

Dehydration may occasion in cases that are severe and this may necessitate the need for hospitalization. Colon inflammation (colitis) is caused by clostridium difficile or c. difficile infection. Patches of tissues that are raw may be formed sometimes. These tissues usually produce pus (pseudo membranous colitis) or bleed.

The signs and symptoms that indicate severe clostridium difficile or c. difficile infection are:

  • 10-15 time diarrhea on a daily basis
  • Pain in the abdomen and cramps which might be severe.
  • Feces will be having pus or blood
  • Fever
  • Nausea
  • Appetite will be lost
  • Dehydration
  • Loss of weight
  • The abdomen will be swollen.
  • Kidneys will fail
  • The count of white blood cell will increase.

What are the Risk Factors for Clostridium Difficile or C. Difficile Infection?

There is some factor that increases the risk of clostridium difficile or c. difficile infection:

The risk factors associated with Antibiotics and other medications intake are:

  • Recently or currently taking antibiotics.
  • Consuming a wide range of antibiotics targeting different bacteria
  • Multiple uses of antibiotics
  • Long time intake of antibiotics
  • Medications that aim to reduce acids in the stomach including Proton pump inhibitors. (PPIs).

Long Term Stay in a Facility for Health Care

Exposure to long term health care facilities for a lengthy span of time may cause infection of clostridium difficile. This is because in places like nursing homes and hospitals, germs tend to be spreading easily. In this consideration a lot of people tend to use antibiotics because of their vulnerability to infections. The spread of clostridium difficile or c. difficile infection is through hands of different persons in nursing homes and hospitals. Other devices that may see the spread of clostridium difficile in such platforms are: toilets, thermometers, stethoscopes, bedside tables, sinks, and bedrails, cart handles or even remote controls and telephones.

Serious Medical Procedure or Having Illness

  • Serious illnesses like colorectal cancer or inflammatory bowel disease poses more chances of contracting clostridium difficile or c. difficile infection.
  • If your immune system has been weakened owing to some treatment or medical condition, for example chemotherapy.
  • Gastrointestinal procedure or abdominal surgery can also increase the risk of getting clostridium difficile.

Another factor for getting infected with clostridium difficile is old age. In a research, it was indicated that the risk of C. difficile infection was higher ten times in individuals older than 65 years as compared to those of younger individuals.

The risk of recurrence of clostridium difficile is 20 times more after each subsequent recurrence and there is increased risk after each.

What Tests are Conducted to Diagnose Clostridium Difficile or C. Difficile Infection?

Anyone who has taken antibiotics recently and is now suffering from diarrhea will be a clear indication for the doctor to suspect clostridium difficile or c. difficile infection. This can also happen to people who are in hospital and are taking antibiotics. The following tests are likely going to be applied if you have such condition:

Stool Test to Diagnose Clostridium Difficile or C. Difficile Infection

A sample of blood in your stool can prove to be containing bacteria of C. difficile. The lab tests that exist include:

  • Enzyme immunoassay. Enzyme known as immunoassay (EIA) is used by most labs. The test is faster but it does not give detailed information and can give false information on normal tests. The reason is because this procedure is not as sensitive enough to detect various infections.
  • Polymerase chain reaction. Toxin B gene is detected in the stool sample. This molecular test is sensitive and clostridium difficile or c. difficile infection can be detected fast and accurately. Most laboratories are now adapting this test and its availability is now becoming wide.
  • Cell cytotoxicity assay. The test of citotoxicity entails looking for the effects of toxins of clostridium difficile in human cells that are developed in a culture. Though this test is sensitive, its availability is not wide. The test results may take more that 24-48 hours to be concluded and the process is unwieldy. In order to ascertain the accurate infections, most hospitals use both cytotoxicity assay and EIA stool tests.

It will be unnecessary to have a clostridium difficile or c. difficile infection test if your stool is not watery and you do not have any diarrhea.

Colon Examination for Clostridium Difficile or C. Difficile Infection

The inside of the colon, might be examined in rare instances. Your doctor may only do this in order to ascertain the proper clostridium difficile diagnosis to administer. A flexible tube will be inserted into the end of the colon with a camera. The aim will be to look for pseudomebranes and inflamed areas. The process is known as flexible colonoscopy or sigmoidoscopy.

Imaging Tests for Clostridium Difficile or C. Difficile Infection

If concerns about clostridium difficile are shown by your doctor, a computer tomography (CT) scan or abdominal X-ray may be ordered. Images of the colon are shown and this enables the detection of abnormalities in the colon. For example, thick walls of the colon. The bowel might be expended too and in some rare occasions a hole/perforation can appear in your colon’s lining.

How is Clostridium Difficile or C. Difficile Infection Treated?

In order to stop clostridium difficile or c. difficile infection you must stop taking the antibiotics that started the infection. The treatment will depend on extent, and the severity of your infection. It may involve the following steps.

Antibiotics for Clostridium Difficile or C. Difficile Infection

It is an irony but the standard medication for treating clostridium difficile or c. difficile infection is another antibiotic. The growth of the clostridium difficile is prevented by the antibiotic and thus the diarrhea is treated and any other complications.

Metronidazole (Flagyl) may be prescribed by the doctor in mild and moderate condition of the infection. It has been shown that metronidazole is effective in treating mild to moderate clostridium difficile despite the fact that it has not been approved by FDA. Bitter taste in the mouth and nausea are some of the side-effects of metronidazole.

In cases that are severe and recurring clostridium difficile a prescription of vancomycin (vancocin), which is also taken orally, can be recommended.

Another antibiotic that has been proved to treat clostridium difficile or c. difficile infection and can be taken through mouth is fidaxomicin (Dificid). The rate of recurrence was low for those people who used fidaxomicin, was low as compared to those who took vacomycin, according to a study. The price of fidaxomicin is however high as compared to those of vancomycin and metronidazole. Nausea and abdominal pain are the main side effects associated to fidaxomicin and vancomycin.

Surgery for Clostridium Difficile or C. Difficile Infection

The only option for people with organ failure, inflamed linings of the walls of the abdomen, severe pain, may require surgery.

Recurrent Clostridium Difficile or C. Difficile Infection

The reason for re-infection of clostridium difficile or c. difficile infection in more than 20% of all individuals are that it is either a new strain of bacteria has re-infected or maybe the previous infection never cleared away in total.

Recurrence risks will be higher if:

  • Your age is more than 65
  • While taking the antibiotics for treating clostridium difficile you are taking other antibiotics.
  • If you have a medical condition that is severe: Chronic liver disease, inflammatory bowel disease or chronic kidney failure are some of the examples.

The Treatment for a Recurrent Condition may Entail:

Antibiotics for Clostridium Difficile or C. Difficile Infection

The therapy of antibiotics when it comes to recurrent infection may be involving a single phase or more courses of treatment (typically vancomycin) which is a gradual tapered dose of medicine. These antibiotics can also be given once after every few days in a process called a pulse regimen. The use of antibiotic therapy is effective up to 60% and it declines further with each re-infection that recurs subsequently.

Fecal Microbiotic transplant (FMT) for Clostridium Difficile or C. Difficile Infection

This process is also known as stool transplant. It is a trending alternative strategy for effective treatment of recurrent clostridium difficile. The clinical studies of FMT are underway as per now despite the fact that it has not been proved by FDA.

A donor stool is placed in the patient’s colon which allows FMT to restore healthy intestinal bacteria. The instruments used are nasogastric tube or a colonoscope. Before using a donor stool it must be scanned first for bacteria, antibodies, viruses and parasites.

The percentage rate for using FMT for C. difficile treatment is higher than 90% according to research. The results were positive in a trial that was conducted randomly. Over 94% was the positive result that prompted the early termination of the trial test.

Probiotics for Clostridium Difficile or C. Difficile Infection

Bacteria and yeast are some of the examples of probiotics. They usually help in restoring the intestinal tract back to having a healthy balance. Saccharomyces boulardii is an example of yeast that helps to prevent the recurrence of clostridium difficile or c. difficile infection when used with antibiotics.


  1. Mayo Clinic. (2021). Clostridium difficile infection. https://www.mayoclinic.org/diseases-conditions/c-difficile/symptoms-causes/syc-20351691
  2. WebMD. (2021). What Is C. Diff? https://www.webmd.com/digestive-disorders/clostridium-difficile-colitis#1
  3. American College of Gastroenterology. (2013). Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections. https://journals.lww.com/ajg/Fulltext/2013/02000/Guidelines_for_Diagnosis,_Treatment,_and_Prevention.4.aspx
  4. Gupta, S. (2018). Fecal Microbiota Transplantation for Clostridium difficile Infection: Understanding Scope of Use. Journal of Clinical Gastroenterology, 52(4), 321-327. https://journals.lww.com/jcge/Abstract/2018/04000/Fecal_Microbiota_Transplantation_for_Clostridium.1.aspx
Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 10, 2023

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