Clostridium difficileOverview

Clostridium difficile, also known as C. difficile or C. diff, is bacteria that can infect the bowel and cause diarrhoea.

The infection most commonly affects people who have recently been treated with antibiotics. It can spread easily to others.

C. difficile infections are unpleasant and can sometimes cause serious bowel problems, but they can usually be treated with another course of antibiotics.

Symptoms of a C. difficile infection

Symptoms of a C. difficile infection usually develop when you're taking antibiotics, or when you have finished taking them within the last few weeks.

The most common symptoms are:

• diarrhoea several times a day
• fever
• loss of appetite
• feeling sick
• tummy pain

In some cases, you may have signs of dehydration.

Who's most at risk of C. difficile?

C. difficile mostly affects people who:

• have been taking antibiotics that work against several types of bacteria (broad-spectrum antibiotics) or several different antibiotics at the same time, or those taking long-term antibiotics
• 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 caused by a condition like diabetes or as a side effect of a treatment such as chemotherapy or steroid medication
• are taking a medication called a proton pump inhibitor (PPI) to reduce the amount of stomach acid they produce
• have had surgery on their digestive system

When to get medical advice

See a GP if you think you have got C difficile. They may suggest sending off a sample of your poo to get it tested for C. difficile in a laboratory.

Having diarrhoea while taking antibiotics doesn't necessarily mean you have C. difficile.

Diarrhoea can be caused by a number of conditions and is a common side effect of antibiotics.

A blood test may also be needed to help determine how severe the infection is.

Sometimes you may need other tests or scans in hospital to check if your bowel is damaged.

Treatment for C. difficile

Your GP will advise if you need hospital treatment (if you're not already in hospital).

If the infection is mild, you should be able to recover at home.

If you're in hospital, you might be moved to a room of your own during treatment to reduce the risk of the infection spreading 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, serious infections may require surgery to remove a damaged section of the bowel

C. difficile infections usually respond well to treatment, with most people making a full recovery in a week or two.

But the symptoms come back in around 1 in 5 cases, and treatment may need to be repeated.

Looking after yourself at home

If you're well enough to recover at home, the following measures can help relieve your symptoms and prevent the infection spreading:

• make sure you finish the entire course of any antibiotics you're 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
• don't take anti-diarrhoeal medication, as this can stop the infection being cleared from your body
• regularly wash your hands and contaminated surfaces, objects or sheets
• stay at home until at least 48 hours after your last episode of diarrhoea

Your GP may contact you regularly to make sure you're getting better. Call them if your symptoms return after treatment finishes, as it may need to be repeated.

How you get C. difficile

C. difficile bacteria are found in the digestive system of about 1 in every 30 healthy adults.

The bacteria often live harmlessly because other bacteria normally found in the bowel keep it under control.

But some antibiotics can interfere with the balance of bacteria in the bowel, which can cause the C. difficile bacteria to multiply and produce toxins that make the person ill.

When this happens, C. difficile can spread easily to other people because the bacteria are passed out of the body in the person's diarrhoea.

Once out of the body, the bacteria turn into resistant cells called spores.

These can survive for long periods on hands, surfaces (such as toilets), objects and clothing unless they're thoroughly cleaned, and can infect someone else if they get into their mouth.

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

How to stop C. difficile spreading

C. difficile infections can be passed on very easily.

You can reduce your risk of picking it up or spreading it by practising good hygiene, both at home and in healthcare settings.

The following 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, particularly after going to the toilet and before eating – use liquid rather than bar soap
• clean contaminated surfaces (such as the toilet, flush handle, light switches and door handles) with a bleach-based cleaner after each use
• 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, observe any visiting guidelines, avoid taking any children under the age of 12, and wash your hands with liquid soap and water when entering and leaving ward areas – do not 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

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