C.difficile (C.diff)

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 38ºC (100.4ºF)
painful abdominal cramps

A C. difficile infection can also lead to life-threatening complications such as severe swelling of the bowel from a build-up of gas (toxic megacolon).

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.

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.

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.

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).