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Understanding Clostridium Difficile (C. diff): Symptoms, Causes, and Treatment Options

Oghenefejiro Okifo | MD

Medically reviewed by Oghenefejiro Okifo | MD, Harvard Medical School | Henry Ford Hospital - Detroit, MI on November 16th, 2023.

Key Takeaways

  • This spore-forming bacterium causes 29,000 deaths annually in the US and occurs in 2-8% of patients receiving antibiotics, particularly fluoroquinolones, clindamycin, and broad-spectrum penicillins.

  • Symptoms typically begin 5-10 days after antibiotic exposure, with watery diarrhea (3+ episodes daily), cramping, and fever; severe cases develop pseudomembranous colitis with bloody stools.

  • Adults over 65 face 10 times higher risk, and healthcare facility stays beyond 4 weeks dramatically increase exposure to resistant spores that survive standard cleaning agents.

  • First-line treatment uses fidaxomicin 200mg twice daily for 10 days, which reduces recurrence rates to 15% compared to 27% with vancomycin.

  • Recurrence occurs in 20-30% of cases, with fecal microbiota transplant achieving 90% cure rates for multiply recurrent infections by restoring normal gut flora.

Clostridium Difficile (C. diff) is a type of bacteria that can cause a serious infection in the colon, leading to severe inflammation and diarrhea. C. diff infections often occur after a person has been taking antibiotics, which can disrupt the balance of healthy bacteria in the gut. In some cases, C. diff infections can be life-threatening.

Symptoms of C. diff Infections

The symptoms of C. diff infections can range from mild to severe and may include:

  • Watery diarrhea (three to four times a day for several days)

  • Stomach pain, cramping, or tenderness

  • Blood or pus in the stool (in more serious infections)

  • Fever

  • Nausea

  • Loss of appetite and weight loss

  • Dehydration

  • Rapid heart rate

If you experience severe diarrhea or any of the above symptoms, seek medical attention promptly to prevent life-threatening complications.

Causes and Risk Factors for C. diff Infections

C. diff bacteria are found in the environment, including air, water, soil, and the feces of humans and animals. The bacteria can form spores that survive on surfaces for extended periods. When ingested, these spores can become active in the intestines and cause infection.

Certain factors can increase your risk of developing a C. diff infection, such as:

  • Taking antibiotics, especially fluoroquinolones, cephalosporins, penicillins, and clindamycin

  • Being 65 years or older

  • Having a weakened immune system due to cancer treatment or other health problems

  • Having a condition like colorectal cancer or inflammatory bowel disease

  • Staying in a healthcare facility, such as a hospital or nursing home

  • Previous C. diff infections

Understanding Clostridium Difficile (C. diff): Symptoms, Causes, and Treatment Options

Complications of C. diff Infections

If left untreated, C. diff infections can lead to serious complications, including:

  • Dehydration due to severe diarrhea, which can affect blood pressure, kidney function, and overall health

  • Toxic megacolon, a condition where the colon dilates and can't release gas or stool, potentially leading to rupture

  • Bowel perforation, a hole in the large intestines that allows dangerous bacteria to escape, causing peritonitis

Diagnosing C. diff Infections

To diagnose a C. diff infection, your doctor may order one or more stool tests, such as an enzyme immunoassay, polymerase chain reaction, GDH/EIA, or cell cytotoxicity assay. In some cases, imaging tests like X-rays or CT scans may be necessary to assess the severity of the infection and any damage to the colon.

Treatment Options for C. diff Infections

Treatment for C. diff infections typically involves the use of targeted antibiotics, such as fidaxomicin, metronidazole, or oral vancomycin. It's essential to discuss the potential side effects of these medications with your doctor.

In addition to antibiotics, it's crucial to replace fluids lost due to diarrhea by drinking plenty of water, broth, and fruit juices containing salt and sugar. In severe cases with intestinal damage, surgery may be necessary to remove the affected areas.

For recurrent C. diff infections, a fecal microbiota transplant (FMT) may be recommended to repopulate the colon with healthy bacteria. This procedure involves transferring stool from a carefully screened donor into the patient's colon using a colonoscope.

Preventing C. diff Infections

To reduce your risk of developing a C. diff infection, especially in healthcare settings, follow these preventive measures:

  • Wash your hands thoroughly with soap and water, particularly after using the bathroom and before eating

  • Request that healthcare professionals wash their hands before and after caring for you

  • Ensure that all medical equipment is sanitized before being brought into your room

  • Avoid taking unnecessary antibiotics and only use them as prescribed by your doctor

By understanding the symptoms, causes, and risk factors associated with C. diff infections, you can take steps to protect yourself and seek prompt medical attention if necessary. Remember, early diagnosis and treatment are essential for preventing serious complications and ensuring a full recovery.

For more information on C. diff infections, visit:

The Bottom Line

Early recognition and appropriate antibiotic treatment can prevent this potentially fatal infection from progressing to toxic megacolon or colonic perforation. Anyone experiencing persistent diarrhea after recent antibiotic use should seek immediate medical evaluation. If you're concerned about symptoms following antibiotic treatment, Doctronic can help assess your risk and guide next steps.

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