Clostridioides difficile, often called C. difficile or C. diff., is a bacteria spread by microscopic spores. Clostridium difficile is the former name. The bacteria cause inflammation of the gut or colon – colitis. This can lead to moderate-to-severe diarrhea, and sometimes to sepsis, which can develop as the body tries to fight the infection. Sometimes incorrectly called blood poisoning, sepsis is the body’s life-threatening response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.
Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly), and/or amputations.
Most C. difficile infections occur in hospitals or healthcare facilities. These are called healthcare-acquired infections, or HAIs. However, physicians are finding that more and more, people are coming into contact with the bacteria in the community.
How does C. difficile spread?
The Clostridium difficile bacteria are found in stool, or fecal matter, and are spread from person to person through direct and indirect means. When people have the bacteria on their hands and they touch their mouth, they may get the bacteria in their system.
Not everyone who has the bacteria becomes ill, however, so it is possible to spread the infection unknowingly.
Direct contact: Someone who has the bacteria on their hands touches someone else, transferring the germs to the other person.
Indirect contact: The germs can stay alive for quite a while on surfaces, such as bedside tables, elevator buttons, doorknobs, telephones, and even clothing. People with the bacteria on their hands touch these objects. Others then touch them.
- Watery diarrhea (at least three bowel movements per day for two or more days). Diarrhea caused by C. difficile has as particular odor.
- Decrease or loss of appetite
- Abdominal pain, bloating, tenderness.
If the infection progresses and becomes more severe, there may also be:
Risk Factors for Contracting C. Difficile Infection
People who are in hospitals or other healthcare settings are at highest risk of developing C. difficile infections. Other people are those who:
- Are over 65 years
- Have serious illnesses, particularly those that can weaken the immune system
- Are taking or who have recently taken antibiotics
- Are taking medications to manage stomach acid, including those known as proton pump inhibitors
- Have had previous C. difficile infections.
The only way to prevent developing an infection with C. difficile is by avoiding exposure to the bacteria. The most effective method to do this is by frequent and proper hand washing with soap and water by everyone, patients, visitors, and anyone who works in the healthcare facilities. Waterless hand cleaners do not adequately kill C. difficile.
Patients who have C. difficile infection should be isolated from other patients to avoid spreading the bacteria. Healthcare workers who enter isolation rooms have to wear gloves and gowns. Reducing antibiotic overuse also reduces the risk of C. difficile infection. This means not asking for antibiotics for viral infections (like colds and the flu) and not taking someone else’s medications.
Treatment for C. Difficile Infection
Doctors use specific antibiotics to treat C. difficile, usually metronidazole (Flagyl) first. If metronidazole doesn’t work, the second medication is usually vancomycin (Vancocin). A more costly antibiotic, fidaxomicin (Dificid), may be effective if neither metronidazole or vancomycin has worked.
In severe cases, a surgeon may need to remove the affected part of the colon.
Testing is ongoing for a new procedure called fecal microbiota transplant (FMT), or a stool transplant. Physicians introduce a donor’s stool into the affected person’s colon with a colonoscope or nasogastric tube. Researchers are also trying capsules as a better delivery method.
The CDC reports that about 20% of people experience a recurrence of C. difficile infection, sometimes repeatedly. However, testing with FMT is showing a high success rate in eliminating the infection altogether.
If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.”
The Sepsis and C. Difficile section has been developed in partnership with the C. Diff Foundation.
The information here is also available as a Sepsis Information Guide, which is a downloadable format for easier printing.
Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.
Updated November 1, 2021.