Clostridioides difficile, also known as C. diff, is a type of bacteria that can cause inflammation of the colon (colitis), leading to symptoms ranging from mild diarrhea to life-threatening conditions. The infection typically arises after the use of antibiotics that disrupt the balance of healthy gut bacteria, allowing C. diff to thrive.

C. diff infections are a major concern in healthcare settings, particularly among older adults and individuals with weakened immune systems. With nearly half a million infections annually in the United States, timely diagnosis and proper treatment are critical for reducing complications and preventing transmission.

Types of Infection

C. diff infections are generally categorized based on severity:

Non-severe Mild infections that cause diarrhea but do not significantly alter laboratory markers such as white blood cell count or kidney function. These cases usually respond well to oral antibiotics.

Severe Characterized by higher white blood cell counts (>15,000 cells/µL), low albumin levels, and increased creatinine levels, which indicate impaired kidney function. These patients often require closer monitoring and sometimes hospitalization.

Fulminant The most critical form of C. diff infection, often resulting in serious complications such as:

  • Hypotension (low blood pressure)

  • Septic shock

  • Ileus (bowel paralysis)

  • Toxic megacolon (severe colon dilation)

  • Risk of death without urgent treatment

Common Symptoms

Many people carry C. diff bacteria without any symptoms. However, once the bacteria begin producing toxins, the following symptoms may appear:

Typical Symptoms:

  • Watery diarrhea lasting more than 3 days

  • Stomach cramps

  • Nausea

  • Appetite loss

  • Fever

Severe Symptoms:

  • Dehydration

  • Abdominal bloating and pain

  • Low blood pressure (shock)

  • Swelling in hands, feet, or face from protein loss

  • Signs of kidney dysfunction

In extreme cases, complications like bowel perforation or sepsis may occur, requiring emergency intervention.

What Causes C. Diff?

C. diff bacteria produce two potent toxins: toxin A and toxin B. These toxins damage the intestinal lining and provoke inflammation, leading to diarrhea and other gastrointestinal symptoms.

Key causes and contributing factors include:

  • Antibiotics: Especially clindamycin, cephalosporins, fluoroquinolones, and penicillin combinations.

  • Hospital environments: Contaminated surfaces and healthcare workers can spread spores.

  • Impaired gut microbiota: After antibiotic use, the natural defense against C. diff is weakened.

  • Contaminated surfaces or hands: The bacteria form spores that can survive for months on objects.

Risk Factors

You are more likely to get a C. diff infection if:

  • You are over age 65

  • You've recently taken antibiotics

  • You have a weakened immune system (HIV, cancer, post-transplant)

  • You've been recently hospitalized or had surgery

  • You live in a nursing home or long-term care facility

  • You've had a previous C. diff infection

How It's Diagnosed

Stool Testing: Stool samples are examined for:

  • Glutamate dehydrogenase (GDH) antigen

  • Toxin enzyme immunoassay (EIA)

  • PCR for toxin B gene

Usually, two or more tests are used together to confirm diagnosis.

Other Diagnostic Tools:

  • Blood tests: Evaluate WBC, albumin, and inflammatory markers like C-reactive protein.

  • Imaging: Abdominal X-rays or CT scans check for inflammation, ileus, or megacolon.

  • Endoscopy: In some cases, colonoscopy may reveal pseudomembranous colitis.

Treatment Options

Treatment focuses on eliminating the infection and managing symptoms.

Antibiotics

  • Vancomycin (oral): First-line treatment

  • Fidaxomicin: Effective alternative with lower recurrence rates

  • Metronidazole: Less preferred, used in mild cases or when other drugs are unavailable

Severe Cases

  • Hospitalization

  • Intravenous fluids

  • Blood pressure support (for shock)

  • Surgery in case of bowel perforation or toxic megacolon

Recurrent Infections If the infection comes back, options include:

  • Fecal Microbiota Transplant (FMT): Transferring healthy stool to restore gut flora

  • Extended antibiotic tapering regimens

  • Bezlotoxumab: A monoclonal antibody that neutralizes C. diff toxin B

Prevention Tips

Hygiene Practices:

  • Wash hands with soap and water (alcohol-based sanitizers do NOT kill spores)

  • Disinfect surfaces using bleach-based cleaners

  • Isolate infected individuals in healthcare settings

Medication Practices:

  • Avoid unnecessary antibiotic use

  • Use probiotics (with caution) to support gut health

Lifestyle and Environment:

  • Maintain a balanced diet

  • Avoid sharing restrooms during active infection

  • Clean bathroom surfaces frequently if you're recovering at home

Related Conditions

C. diff is more likely to occur or worsen in individuals with:

  • Inflammatory Bowel Disease (IBD): Such as Crohn's disease or ulcerative colitis

  • Recent gastrointestinal surgery: Which alters the intestinal microbiome

  • Immunocompromised states: Such as chemotherapy, organ transplant, or chronic disease

Living With C. Diff

While C. diff can be frightening, most people recover fully with timely treatment.

Recovery Tips:

  • Stay hydrated

  • Complete the full course of antibiotics

  • Follow up with your healthcare provider

  • Maintain gut health through nutrition and possible probiotics

Chronic Cases: For those who suffer recurrent infections, long-term solutions like fecal transplants or monoclonal antibody therapy may be necessary. Psychological support is also helpful due to the stress and stigma associated with recurring diarrhea.