Clostridium difficile

About Clostridium difficile infection

Most children and about three in 100 adults have C. difficile in their bowel. This doesn’t usually cause any problems in healthy people because the growth of C. difficile is controlled by other types of bacteria. However, some antibiotics destroy the bacteria that usually prevent C. difficile from multiplying. If this happens, the number of C. difficile in your bowel can increase and cause symptoms of the infection.

C. difficile infection that causes symptoms is much more common in older people – mostly those who are over 65. People in hospital are particularly vulnerable to C. difficile infection because they are already unwell and may also be taking antibiotics.

The infection can spread from person to person via C. difficile spores, which are tiny parts of the bacteria that are able to reproduce. They can survive for long periods of time outside your body, for example on surfaces and clothes. The spores can only be destroyed by thorough cleaning with soap and water or disinfectant – alcohol gels aren’t as effective.

Symptoms of Clostridium difficile infection

The symptoms of C.difficile infection can include:

  • diarrhoea
  • abdominal (tummy) pain
  • blood in your faeces
  • a high temperature
  • loss of appetite
  • feeling sick

The symptoms of C.difficle infection can last for a couple of days to a few weeks.

These symptoms may be caused by problems other than C.difficile infection but if you have them, and have recently been treated with antibiotics (especially older adults) you should see your GP.

Complications of Clostridium difficile infection

Sometimes, C. difficile infection can cause inflammation (colitis) of your bowel. If this is severe, you can be at risk of developing a life threatening condition known as pseudomembranous colitis. Rarely, a C. difficile infection can lead to your bowel perforating (tearing) and blood poisoning, which can be fatal.

Causes of Clostridium difficile infection

C. difficile infection is usually caused by taking antibiotics for another illness. You're more at risk of getting C. difficile infection if you're taking broad spectrum antibiotics. These are antibiotics that act against a wide range of disease-causing bacteria, but can also destroy the natural bacteria in your bowel, leading to overgrowth of C. difficile.

C.difficle infection can spread very easily because the spores can survive outside your body. For example, healthcare workers, people who are in hospital and visitors can spread the spores by touching a contaminated surface (such as furniture, toilets, sinks and taps). This is particularly common in hospitals and care homes.

You may be more likely to get C. difficile infection if you’ve had bowel surgery or if you have a condition such as HIV/AIDS where your immune system isn't able to fight infection as well it should.

Diagnosis of Clostridium difficile infection

As a number of different conditions can cause similar symptoms to those of C. difficile infection, it may be difficult for your GP or doctor to diagnose. He or she may ask you for a sample of your faeces (stool sample), which will be sent to a laboratory for testing.

Treatment of Clostridium difficile infection

If you have a mild C. difficile infection, the only treatment you may need is to stop taking the antibiotics that are causing you to become unwell. You will also need to make sure you drink enough fluids to replace those that you will have lost as a result of having diarrhoea. If you’re in hospital, you may need to have fluids given to you through a drip.

If you have a more serious infection, you may be prescribed a different antibiotic to the one you’ve been taking. Antibiotics usually prescribed for C.difficile infection are metronidazole or vancomycin. You will need to take the antibiotics for at least 10 days and make sure you finish your course of treatment, even if your symptoms clear up. You will usually be able to go back to work or school when you haven’t had diarrhoea for at least 48 hours.

Even if the antibiotics get rid of your infection, there is a possibility that it can come back. This happens to about three out of 10 people who develop C. difficile infection. If your symptoms return, let your GP know as soon as possible.

If you have severe bowel inflammation, you may need surgery to remove the infected part, but this is rare.

Prevention of Clostridium difficile infection

If you're infected with C. difficile or have been in contact with someone who has the infection, it's very important that you take steps to help stop it spreading to anyone else. You can do this by making sure you always wash your hands with soap and water after going to the toilet and before preparing or eating food. You should also regularly clean your kitchen and bathroom using disinfectant or household detergents.

If you’re in hospital and have C.difficle infection, you will usually be moved into a single room or to an area where other people also have the infection. The hospital staff will follow strict hygiene rules to prevent the C.difficle infection spreading. Any visitors you have should wash their hands with soap and water before and after they visit you. Alcohol gels aren’t effective at killing C.difficile spores, so won’t prevent the infection.

Video

See our video about Clostridium difficile infection:

How should I wash my hands to reduce the spread of hospital infection?

Can I get a Clostridium difficile infection even if I'm not in hospital?

Answer

Yes, it's possible to become infected with Clostridium difficile (C. difficile) in the community, but it's much less common outside a hospital or similar environment, such as a nursing home.

Explanation

C. difficile is a type of bacteria. A small number of people naturally have C. difficile in their bowel, but it doesn't make them unwell because it's controlled by other types of bacteria. C. difficile spores (tiny parts of the bacteria that are able to reproduce) can be spread through the diarrhoea of infected people and passed to others through hand-to-hand contact, or through contact with contaminated objects such as bedpans, toilets or furniture surfaces.

The spread of C. difficile infection is more likely to occur in hospitals, where people are unwell, and in places such as nursing homes where there are many people in close contact with one another. This means that if one person develops C. difficile infection, it can spread quickly to other vulnerable people.

Although less likely it’s possible to get C. difficile infection if you’re not in hospital. If this happens, you will need to stay off work or school until you haven't had diarrhoea for at least 48 hours. It's also important to take steps to stop the infection spreading to others. You can do this by making sure you always wash your hands with soap and water after going to the toilet and before preparing or eating food.

Are there different types of Clostridium difficile?

Answer

Yes, scientists have identified more than 100 different types of C. difficile bacteria. Some types can cause more serious symptoms than others.

Explanation

There are over 100 different types of C. difficile bacteria. One of these is called type 027 and has been identified as the cause of the most serious outbreaks of C. difficile infection. It's more severe because it produces more of the toxins (poisons) that attack the cells in your bowel and it's able to spread very easily from person to person.

Do I have to stay in hospital while I have a Clostridium difficile infection?

Answer

Yes, if you're already in hospital you will need to stay there for treatment until you haven’t had diarrhoea for at least 48 hours.

Explanation

You will need to stay in hospital and away from work or school until your bowel movements have returned to normal. This is because you could pass the C. difficile infection on to someone else.

When you're in hospital, you will need to stay in a separate room so that the infection isn't spread to other people. However, this isn't always possible, so you may be put in a special area with other people who also have C. difficile infections. If you have any visitors, they will need to wash their hands with soap and water before they come into and before they leave the ward.

Once you're able to leave hospital, you won't need any special treatment. However, you should take care to always wash your hands with soap and water after going to the toilet or preparing food, and make sure the environment you're living in is cleaned regularly with disinfectant.

What kind of measures do I need to take if I'm looking after someone who has a Clostridium difficile infection at home?

Answer

If you're looking after someone at home who has been diagnosed with a C. difficile infection, it's important to maintain good hygiene, so that other family members aren't put at risk.

Explanation

It’s important to follow good hygiene measures in order to reduce the risk of C. difficile spreading to other members of your family.

Good hygiene measures include the following.

  • All family members should wash their hands regularly using soap and water, especially after using the toilet and before preparing and eating food.
  • Regularly clean all surfaces with disinfectant in the area around the person who is infected and in the bathroom, particularly toilet seats, showers, baths, sinks, taps and handles using disinfectant.
  • Throw away any cleaning cloths you’ve used to clean surfaces, or wash them at 60°C or above.
  • Keep the sheets, pillows and clothes of the infected person separate from the rest of the family laundry and wash them at 60°C or above.