C. Difficile (C. diff)

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 sepsis, which can develop as the body tries to fight the infection. Sepsis, which was often called blood poisoning, 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 Clostridioides difficile bacteria are found in stool (fecal matter), and are spread from person to person through direct and indirect contact.

Not everyone who has the bacteria becomes ill, however. 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 bacteria 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, transferring the bacteria to their own hands.

Symptoms

  • 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. Others 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.

Prognosis

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.

Suggested Citation: Sepsis Alliance. Sepsis and C. Difficile (C. diff). 2022. https://www.sepsis.org/sepsisand/c-difficile/

Updated October 18, 2022.

Read Personal Stories of Sepsis and C. Difficile (C. diff)

Robert Helton

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In February 2021 I received care from a neighborhood physician’s assistant for a hangnail that had become infected. After having the infection drained, I was prescribed an antibiotic. Two weeks later I became ill with severe diarrhea and returned to the same office. (Sepsis and Bacterial Infections) I was prescribed Cipro and Flagyl for potential diverticulitis and my symptoms subsided. Another two weeks passed and again, I was sick again with the same symptoms and visited my primary care physician and was again prescribed Cipro and Flagyl and the physician’s assistant also ordered a CT scan that later revealed irritation ... Read Full Story

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Mary Raich

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I had gone to Florida with friends for a girls weekend. I felt fine when we left. The next morning I woke up not feeling well and stayed in bed all day and night. At 5am I woke up to use the bathroom and passed out. My friends called 911. My pulse oxygen was 84. I had severe diarrhea, extremely low blood pressure and a lot of pain. Doctors admitted me to the ICU with C-diff, sepsis and septic shock. (Sepsis and C. Difficile, Sepsis and Septic Shock) My kidneys and liver where failing and they were struggling to keep ... Read Full Story

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Mary Lansing

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This story is about my mother Mary. She was a healthy dialysis patient. (Sepsis and Invasive Devices) She didn’t want to get an infection so she agreed to have a graft put under her skin which was safer than having a dialysis catheter. She always was careful to follow the doctor’s advice. One night after dialysis, she got up from bed to go to the bathroom. And got dizzy and fell and broke her ankle in many places. When she got to the emergency room, she was found to be septic and that was what caused her to fall. Not ... Read Full Story

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Amy May

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In 2018 I was 28 weeks pregnant and started experiencing weird symptoms. I was sick all the time. I was loosing weight. I was constantly dehydrated and couldn’t keep up with my fluids. I was initially diagnosed with C.diff and was put on an antibiotic. (Sepsis and C. diff) While on that antibiotic I developed chills and fevers. I was admitted to the hospital where they drew blood cultures. 5 days later on Christmas Eve I received a phone call stating that my blood cultures had come back positive for Fusobacterium necrophorum. I was admitted at 32 weeks pregnant to ... Read Full Story

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Kimberly Castillon

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I grew up in a house of 7. I was the second oldest, by 18 minutes, to my identical twin. We had another sister a year after we were born and another sister two years after we were born and then 8 years later a brother, along with my mom and dad. David, my brother was the most protected and loved kid there could ever be. He had a heart of gold, loved hanging out with Dad and loved irritating my Mom, in a very teenage son way! He never made it to his high school graduation. He was killed ... Read Full Story

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C. Difficile (C. diff)

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 often deadly response to infection. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.