C. Diff: What You Need to Know

Learn the facts about this nasty, drug-resistant bacteria that can be caused by antibiotics—and treated by them.

man in hospital bed with abdominal stomach pain

Updated on November 16, 2023.

It may be the biggest health issue you haven’t heard about. The Clostridioides difficile bacteria, commonly known as C. diff, is believed to cause nearly half a million infections each year in the United States. Many of those infected become seriously ill, and for a significant number, it can turn deadly. About 9 percent of people over age 65 who develop a C. diff infection in a healthcare setting will die within one month. 

C. diff is spread largely in healthcare settings, though infection rates in hospitals and rehab facilities have dropped greatly in recent years. But C. diff can be passed on in other places, too. More than half of C. diff cases in 2020 were community-associated, meaning people became infected outside of hospitals or inpatient medical facilities, according to a 2023 review in the journal Antibiotics.

The Centers for Disease Control and Prevention (CDC) has classified C. diff as an urgent threat, its highest possible rating for a pathogen (germ). But you can take steps to protect yourself and your community, starting with learning about the issue. 

What is C. diff?

C. diff is a bacteria that is found in feces and lives in the intestines of many people. It’s usually harmless, kept in check by other, “good” intestinal bacteria. But when that balance is disrupted, C. diff produces toxins that damage the lining of the colon, causing a range of medical problems, from inflammation to potentially deadly diarrhea.

One of the main contributors to C. diff infection is the use of antibiotics. Antibiotics not only kill off the germs that make you sick, they’re strong enough to kill some of the intestinal bacteria that keep C. diff under control.

What are the symptoms?

Symptoms of C. diff infection range from mild to severe. Signs of a mild case may include:

  • Watery diarrhea three times or more in a day
  • Cramping in the abdomen
  • Abdominal tenderness

A more severe reaction may include: 

  • Watery diarrhea 10 to 15 times each day
  • Fever 
  • Persistent (constant) abdominal pain
  • Swollen abdomen
  • Loss of appetite
  • Nausea
  • Fast heart rate
  • Blood in the stool (poop)

Who is at risk?

Anyone can get a C. diff infection, even if they have no risk factors. Taking a course of antibiotics increases your risk of being infected, both during treatment and for about a month after it’s completed. 

Additional risk factors for C. diff infection or for developing a more severe case may include:

  • Being age 65 or older
  • Taking antibiotics for more than a week
  • A recent stay in a hospital or nursing home facility
  • Having a weakened immune system
  • Having already had C. diff 

There are additional concerns about the rise of C. diff in children. A 2023 review in Pediatrics noted that 20,000 children develop C. diff infections each year in the U.S. The vast majority are community-associated.

How does C. diff spread?

The bacteria live—and are shed—in the feces of people who are infected. In hospital settings, that means toilets, bathroom fixtures, bed linens, and medical equipment are common hot spots for C. diff spores. Making matters worse, the bacteria can live on surfaces for months when they’re not disinfected properly. Hospital workers who touch these surfaces can transmit C. diff to patients for whom they are caring. 

People can also infect themselves or others by touching a contaminated object or shaking the hand of someone who has been contaminated, and then putting their hand to their mouth or nose, giving C. diff an easy entry point.

How is C. diff treated?

If you’re taking an antibiotic when diagnosed with a C. diff infection, your healthcare provider (HCP) may ask you to stop taking it. This may be enough for your body to recover. More serious cases may be treated with metronidazole, vancomycin, or fidaxomicin, three antibiotics known to be effective against disease.  

Symptoms of mild infections usually start easing up within a few days with treatment. People with severe cases may need to be admitted to ICU or have emergency surgery. About 1 in 5 people have recurrences of C. diff infections, which means they relapse between two and eight weeks of treatment and may require additional rounds of antibiotics. 

Your HCP may also recommend probiotics to help build back up your good gut bacteria. Fecal transplantation is another potential fix. This involves transferring a healthy donor’s medically processed feces to the colon of someone for whom repeat antibiotics haven’t worked. 

How can I avoid getting C. diff?

Because the bug is a hardy one, it’s important to practice good hygiene, especially after a visit to an HCP’s office or other healthcare facility. Be sure to:

  • Wash your hands regularly with soap and water. Don’t rely exclusively on alcohol-based hand sanitizers to do the job.
  • Ensure that all surfaces, from doorknobs to mobile phones to keyboards, are cleaned with bleach-based products if you think an infected person has touched them.
  • Make sure to clean any laundry of a sick person—including bed linens, towels, and clothing—in hot water. Use chlorine bleach if possible.

Finally, since overuse and misuse of antibiotics are main culprits for C. diff antibiotic resistance, discuss their use with your HCP. If you do take antibiotics, make sure you take them exactly as prescribed. Stopping them too soon or skipping a dose may alter the microorganisms in your gut, ultimately doing more harm than good.

Article sources open article sources

Buddle J, Fagan R. (2023) Pathogenicity and virulence of Clostridioides difficile, Virulence, 14:1.
U.S. Department of Health and Human Services. Antibiotic Resistance Threats in the United States. PDF last revised December 2019. 
Centers for Disease Control and Prevention. Antibiotic Resistance & Patient Safety Portal: C. difficile infections. Page accessed August 24, 2023.
Centers for Disease Control and Prevention. What is C. diff? Page last reviewed September 7, 2022. 
Guh AY, Mu Y, Winston LG, et al. Emerging Infections Program Clostridioides difficile Infection Working Group. Trends in U.S. Burden of Clostridioides difficile Infection and Outcomes. N Engl J Med. 2020 Apr 2;382(14):1320-1330. 
Liu C, Monaghan T, Yadegar A, et al. Insights into the Evolving Epidemiology of Clostridioides difficile Infection and Treatment: A Global Perspective. Antibiotics. 2023; 12(7):1141.
Cleveland Clinic. C. diff (Clostridioides difficile) Infection. Page last reviewed May 10, 2023. 
Centers for Disease Control and Prevention. Your Risk of C. diff. Page last reviewed June 27, 2022. 
Shirley D, Tornel W, Warren C, et al. Clostridioides difficile Infection in Children: Recent Updates on Epidemiology, Diagnosis, Therapy. Pediatrics 2023; e2023062307.
Centers for Disease Control and Prevention. FAQs for Clinicians About C. diff. Page last reviewed October 25, 2022. 
Centers for Disease Control and Prevention. Prevent the Spread of C. diff. Page last reviewed July 20, 2021. 
Cleveland Clinic. Antibiotic Resistance. Page last reviewed June 23, 2021.

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