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C. Difficile (C. diff)

Clostridioides difficile, often called C. difficile or C. diff., is a bacteria spread by microscopic spores. It used to be called Clostridium difficile. 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 often deadly response to infection. Sepsis kills and disables millions, and requires early suspicion and rapid treatment for survival.

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 Is 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: If someone has the bacteria on their hands and touches someone else, the germs can be transferred 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 who have the bacteria on their hands touch these objects, which are then touched by other people. The bacteria are then picked up by others and may be left behind on other surfaces that they touch.


  • Watery diarrhea (at least three bowel movements per day for two or more days). Diarrhea caused by C. difficile has as particular odor.
  • Fever
  • Decrease or loss of appetite
  • Nausea
  • Abdominal pain, bloating, tenderness.

If the infection progresses and becomes more severe, there may also be:

  • Dehydration
  • Weight loss

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. It has been found that the waterless hand cleansers 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 such an isolation room would have to wear gloves and gowns, which are then removed in a specific manner to keep the spores from leaving the room.

The risk of C. difficile infection can also be reduced by not overusing antibiotics. 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

Specific antibiotics are needed to treat C. difficile. Metronidazole (Flagyl) is usually the first medication prescribed. If this has not been effective, the second medication tried is usually vancomycin (Vancocin). A more costly antibiotic, fidaxomicin (Dificid), may be effective if neither metronidazole or vancomycin has worked.

In severe cases, surgery may be needed to remove the affected part of the colon.

Testing has been done 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. This can be done with a colonoscope or nasogastric tube, but testing has looked at 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 January 12, 2021.