Clostridium difficile

Clostridium difficile (C. difficile) is a bacterial infection of the bowel. It causes severe diarrhoea, and it usually shows up after a course of antibiotics. Along with watery diarrhoea, you may have stomach cramps, dehydration and fever. Most cases are treated with antibiotics that kill the C. difficile bacteria.

• Clostridium difficile (C. difficile) usually develops during or after antibiotic treatment
• It causes watery diarrhoea and abdominal pain
• It's more common in people over 65
• It can spread easily through contamination
• It usually responds well to treatment
• Its symptoms return in around 1 in 5 cases

Yes, antibiotics can cause Clostridium difficile (C. difficile) infection. They can upset the normal balance of bacteria in your bowel. That gives C. difficile bacteria the chance to multiply, and as they multiply they produce the toxins that make you ill.

Yes, you do. In most cases, Clostridium difficile (C. difficile) is treated with antibiotics that kill the bacteria.

Yes, C. difficile is contagious. The infection spreads through resistant cells called spores, and these can live on hands, surfaces and clothing.

Most people with a C. difficile infection get better within 1 to 2 weeks after treatment begins.

Phone your doctor if you have severe diarrhoea, dehydration, fainting, severe abdominal pain or a high fever.

Symptoms of a C. difficile infection usually start while you're taking antibiotics, or within a few weeks of finishing them.

The most common symptoms are:

• watery diarrhoea, which can be bloody
• painful tummy cramps
• feeling sick
• signs of dehydration, such as a dry mouth, headaches and peeing less often than normal
• a high temperature (fever) of above 38C (100.4F)
• loss of appetite and weight loss

In some cases, serious complications can develop, such as damage to the bowel or severe dehydration. Severe dehydration may cause drowsiness, confusion, a rapid heart rate and fainting.

C. difficile mostly affects people who:

• have been treated with broad-spectrum antibiotics (antibiotics that work against several types of bacteria) or several different antibiotics at the same time, or who are taking antibiotics for a long time
• have had to stay in a healthcare setting, such as a hospital or care home, for a long time
• are over 65 years old
• have certain underlying conditions, including inflammatory bowel disease (IBD), cancer or kidney disease
• have a weakened immune system, which can be because of a condition such as diabetes or a side effect of a treatment such as chemotherapy or steroid medicine
• are taking a medicine called a proton pump inhibitor (PPI) to reduce the amount of stomach acid they produce
• have had surgery on their digestive system

Many C. difficile infections used to occur in places where lots of people take antibiotics and are in close contact with each other, such as hospitals and care homes. But strict infection control measures have helped to reduce this risk, and a growing number of C. difficile infections now occur outside these settings.

• you have persistent diarrhoea after finishing a course of antibiotics
• you have bloody diarrhoea
• you have diarrhoea and experience severe tummy pain, a high fever, a rapid heart rate or fainting
• you have symptoms of severe dehydration, such as confusion, drowsiness, only passing small amounts of urine or no urine at all

If your doctor's chamber is closed, phone the 16263 health line.

Visiting your doctor with a possible C.

Diarrhoea can have many causes, and it's a common side effect of antibiotics. So having diarrhoea while you're taking antibiotics doesn't necessarily mean you have a C. difficile infection.

Your doctor may suggest sending a sample of your stool to the laboratory to confirm whether you have C. difficile. A blood test may also be done to help judge how severe the infection is. Sometimes you may need tests or scans in hospital to check whether your bowel is damaged.

Your doctor will decide whether you need hospital treatment (if you're not already in hospital). If the infection is fairly mild, you may be treated at home.

If you're in hospital, you might be moved to a room of your own during treatment, so the infection is less likely to spread to others.

Treatment for C. difficile can include:

• stopping the antibiotics thought to be causing the infection, if possible (in mild cases, this may be the only treatment that's needed)
• taking a 10 to 14-day course of antibiotics that are known to kill C. difficile bacteria
• rarely, surgery to remove a damaged section of the bowel, for serious infections

C. difficile infections usually respond well to treatment, and most people make a full recovery in a week or two. However, the symptoms come back in around 1 in 5 cases, and treatment may need to be repeated.

If your doctor feels you're well enough to be treated at home, a few simple steps can ease your symptoms and stop the infection from spreading to others.

• Finish the whole course of any antibiotics you've been prescribed, even if you're feeling better
• Drink plenty of fluids to avoid dehydration, and eat plain foods such as soup, rice, pasta and bread if you feel hungry
• Take paracetamol for tummy pain or a fever
• Wash your hands often, and wash any contaminated surfaces, objects or sheets too
• Stay at home until at least 48 hours after your last episode of diarrhoea

• do not take anti-diarrhoeal medicine, as this can stop the infection being cleared from your body

Your doctor may contact you regularly to make sure you're getting better. Phone them if your symptoms return after treatment finishes, because the treatment may need to be repeated.

C. difficile bacteria live in the digestive system of about 1 in every 30 healthy adults. Most of the time they do no harm, because the other bacteria normally found in the bowel keep them under control.

Some antibiotics, however, can upset the balance of bacteria in the bowel. When that happens, the C. difficile bacteria can multiply and produce toxins, and these make the person ill.

A person who is ill in this way can pass the infection on easily, because the bacteria leave the body in their diarrhoea. Once outside the body, the bacteria turn into resistant cells called spores. Unless they're thoroughly cleaned away, spores can survive for long periods on hands, surfaces (such as toilets), objects and clothing. They can infect someone else if they get into that person's mouth.

Someone with a C. difficile infection is generally considered to be infectious until at least 48 hours after their symptoms have cleared up.

C. difficile infections pass from person to person very easily. Good hygiene, both at home and in hospitals and clinics, lowers your risk of picking up C. difficile or spreading it to others.

These measures can help:

• Stay at home until at least 48 hours after your symptoms have cleared up.
• Wash your hands regularly with soap and water, especially after going to the toilet and before eating. Use liquid soap rather than bar soap, and don't use flannels or nail brushes.
• Clean contaminated surfaces with a bleach-based cleaner after each use. This includes the toilet, flush handle, light switches and door handles.
• Don't share towels and flannels.
• Wash contaminated clothes and sheets separately from other washing, at the highest possible temperature.
• When visiting someone in hospital, follow the visiting guidelines and avoid taking any children under the age of 12. Wash your hands with liquid soap and water when you enter and leave the ward. Don't rely on alcohol hand gels, as they're not effective against C. difficile.
• Avoid visiting hospital if you're feeling unwell or have recently had diarrhoea.