Introduction

A Clostridium difficile infection is a type of bacterial infection

that can affect the digestive system. It most commonly
affects people who have been treated with antibiotics.
The symptoms of a C. difficile infection can range from mild to
severe and include:
diarrhoea
a high temperature (fever) of above 38C (100.4F)
painful abdominal cramps
A C. difficile infection can also lead to life-threatening
complications such as severe swelling of the bowel from a buildup of gas (toxic megacolon).
Read more about the symptoms of Clostridium
difficile and complications of a Clostridium difficile infection.

Symptoms of Clostridium
difficile infection
The symptoms of a Clostridium
difficile infection usually develop when you are
taking, or have just finished taking, an
antibiotic.
Occasionally, symptoms may appear up to 10
weeks after you finish taking antibiotics.
The most common symptoms of a mild to
moderate C. difficile infection are:

 regular bouts of usually foul-smelling, watery diarrhoea,

which can sometimes be blood-stained (most people have
around three to five bouts of diarrhoea a day)
abdominal cramping and pain

In more severe cases, your colon (large bowel) can

become inflamed this is known as colitis.
Symptoms of colitis include:
more frequent bouts of diarrhoea (between 10 and 15 a day)
a high temperature (fever) of above 38C (100.4F)
more severe abdominal cramping
dehydration
feeling sick
loss of appetite
weight loss

When to seek medical advice

Diarrhoea can be a common side effect of
antibiotics, so having diarrhoea while taking
antibiotics does not necessarily mean you have
a C. difficile infection.
If the diarrhoea persists after finishing your course
of antibiotics, you should contact your GP for
advice.

You should also contact your GP if you experience

additional symptoms, such as a high temperature
or abdominal cramps.

Causes
Spores of the C. difficile bacteria can be passed out of the human
body in faeces (stools) and can survive for many weeks, and
sometimes months, on objects and surfaces.
If you touch a contaminated object or surface and then touch your
nose or mouth, you can ingest the bacteria.
The C. difficile bacteria do not usually cause any problems in
healthy people. However, some antibiotics can interfere with the
natural balance of normal bacteria in the gut that protects against
C. difficile infection.
When this happens, C. difficile bacteria can multiply and produce
toxins (poisons) that cause symptoms such as diarrhoea.
Read more about the causes of a Clostridium difficile infection.

Causes of Clostridium difficile

infection
Clostridium difficile are anaerobic bacteria.
This means they do not need oxygen to survive
and multiply. They therefore survive well in the
colon (bowel), where there is very little oxygen.
C. difficile does not usually affect healthy children
and adults. This is because the bacteria normally

present in the healthy bowel keep it under control.

However, some antibiotics can interfere with the
healthy balance of bacteria.
When this happens, C. difficile bacteria can multiply
and produce toxins (poisons) that cause illness. At
this point, a person is said to have a Clostridium
difficile infection.

Spread of infection
Once C. difficile bacteria start to produce toxins,
the bacteria can spread easily. This is because the
bacteria are now producing spores (a much more
resistant form of the cell) that leave the body in an
infected person'sdiarrhoea.
The spores are resistant to conditions outside the
body and can contaminate toilets, bedclothes, skin
and clothing.
The spores of bacteria are spread by the hands of
healthcare staff and other people who come into
contact with infected patients or contaminated
surfaces.
The spores can also be spread through the air, for
example while making the bed. They can survive

for a long time outside the body unless they

are removed by very thorough cleaning.

Most at risk
People most vulnerable to a C. difficile infection are
those who:
have been treated with broad-spectrum antibiotics
(antibiotics that can treat different types of bacteria), such as
amoxicillin and cefalexin
have had to stay in a healthcare setting for a long time
are over 65 years old
have a serious underlying illness or condition
have a weakened immune system, which can be because of
a condition such as diabetes or a side effect of a treatment
such as chemotherapy
have had surgery on the digestive system

Previously, the majority of infections occurred in

places where many people take antibiotics and are
in close contact with each other, such as hospitals
and care homes.
Control measures have been effectively
implemented to dramatically reduce the number of
infections in healthcare settings. A number of
precautions can be taken to help reduce the spread
of infection.

Read more about preventing a Clostridium difficile

infection.

Community-acquired clostridium difficile infection

In recent years, an increasing number of Clostridium difficile
infections have occurred outside a healthcare setting.
This is known as community-acquired Clostridium difficile
infection.
Research has found that these infections are most common in
middle-aged women (it is unclear why this is the case) and the
symptoms tend to be milder than a "standard" C. difficile infection.
However, serious infections may also be community acquired.

Diagnosing Clostridium difficile

infection
Clostridium difficile infection is usually
first diagnosed based on your symptoms and
whether or not you have been taking
antibiotics.
If necessary, diagnosis can be confirmed by
carrying out laboratory tests on a sample of the
infected person's faeces.
If a C. difficile infection is present, the test will show
C. difficile toxins in the faeces sample.

Blood test
The number of white blood cells in your blood may
also be measured in a blood test.
A very high level of white blood cells would usually
indicate a more severe form of C. difficile infection,
which could have implications for your treatment.
Blood tests can also detect mineral imbalances that
can occur in the blood as a result of dehydration.

Colon (bowel) examination

If your symptoms suggest you may have
complications affecting your colon, it may need to
be examined. This can be done either:
directly by placing a flexible tube containing a camera and
a light source up into your rectum (bottom) and then into
your colon; this is known as a colonoscopy
indirectly by using a computer tomography (CT) scan,
which takes a series of X-rays and uses a computer to
assemble the scans into a more detailed image of your colon

Treating Clostridium difficile

infection

You will only need treatment for a Clostridium

difficile infection if you have symptoms.
No treatment is needed if the bacteria are living
harmlessly in your digestive system.

Mild infection
If you have mild symptoms of a C. difficile infection,
it is best to stop taking the antibiotics that may
have caused the infection, if possible. This will
allow the natural mixture of bacteria to regrow in
your gut.
In many cases where the symptoms are mild,
stopping the antibiotics is often enough to ease the
symptoms and clear the infection.

Moderate to severe infection

If you have symptoms that are more troublesome,
such as severe diarrhoea or colitis (swelling and
irritation of the bowel), you may need to take an
antibiotic that can kill C. difficile bacteria.
The first treatment will usually be metronidazole,
but vancomycin or fidaxomicin may be used as an
alternative in severe cases. This should ease the
symptoms within two to three days, though it can

take around 7 to 10 days to make a complete

recovery.
Possible side effects of these antibiotics are
stomach ache, feeling sick and being sick.

Treating relapses
In around one in four cases, the symptoms of C.
difficile infection return, usually within a week of
completing treatment. This is known as a relapse.
The recommended treatment option for a first
relapse is usually to repeat the original course of
treatment.
If you experience a second relapse, a 14-day
course of vancomycin may be recommended, or an
additional antibiotic such as fidaxomicin or
rifaximin.
If you then go on to experience further relapses,
you may be referred to a specialist in the treatment
of persistent C. difficile infections.
There are a number of treatment options available:
a longer course of vancomycin the dose is gradually
reduced over several weeks
repeat courses of antibiotics such as fidaxomicin

 faecal transplantation
immunoglobulins these contain concentrated
antibodies that are prepared from blood donations

Faecal transplantation
Another newer treatment option for recurring C.
difficile infections is faecal transplantation. This
involves a sample of faeces being taken from a
healthy donor and placed into the colon of
someone with a C. difficile infection using a
catheter. Alternatively, it may be placed using a thin
tube through the nose into the small bowel below
the stomach.
The donated sample restores the normal balance
of bacteria inside your digestive system with that
from the healthy donor.
While this may sound unpleasant, the treatment
does have very good results, with a success rate
of more than 90%, and is probably the best
treatment currently available. However, access to
this type of treatment may be limited.

Treatment
A mild C. difficile infection can usually be controlled by
withdrawing treatment with the antibiotics causing the infection.
More severe cases can be treated using the following antibiotics:
vancomycin
metronidazole
The condition usually responds well to treatment, with symptoms
improving in two to three days and clearing up completely within 7
to 10 days.
However, relapse is common, occurring in around one in four
cases, and requires further treatment. Some people have two or
more relapses.
Life-threatening cases may need surgery to remove a damaged
section of the bowel. This is needed in less than 1% of cases.
Severe cases of C. difficile infection can be fatal, especially when
they occur in people who are already very ill.
Read more about treating a Clostridium difficile infection.

Prevention
C. difficile bacteria spread very easily. Despite this, C. difficile
infections can usually be prevented by practising good hygiene in
healthcare environments, such as washing hands regularly and
cleaning surfaces using products containing bleach.
If you are visiting someone in hospital with C. difficile, you can
reduce the risk of spreading infection by washing your hands
before and after entering the bed space. Alcohol hand gel is not
effective against C. difficile spores, so the use of soap and water
is essential.
Read more about preventing a clostridium difficile infection.

Who is affected?
The majority of C. difficile cases occur in people who have had
antibiotics. This may be in a healthcare setting, such as a hospital

or care home, but can also occur at home without ever going to
hospital.
Older people are most at risk from infection, especially those who
are frail or with medical conditions. People over the age of 65
account for three-quarters of all cases.
In recent years, the number of C. difficile infections has fallen
rapidly. There were 14,687 reported cases in England from April
2012 to March 2013, compared with 52,988 in 2007.
However, a new strain of the C. difficile bacteria called NAP1/027
has emerged in recent years. This new strain tends to cause
more severe infection.
There has also been an increase in the number of C. difficile
infections occurring outside a healthcare setting (known as
community-acquired Clostridium difficile infection).

C difficile
The symptoms of C difficile range from mild to very severe
diarrhoea. Get expert advice on how to avoid it, how it spreads
and treatments that can control the disease.
Media last reviewed: 14/05/2013
Next review due: 14/05/2015

Antibiotics
Antibiotics are medications that are used to treat, and in some
cases prevent, bacterial infections