Clostridium difficile

Clostridium difficile is an infection caused by bacteria. Symptoms include diarrhoea and other more serious conditions which affect the gut. It is usually kept under control by other bacteria that live in the gut that are essential for maintaining good health. The infection often occurs after someone has taken antibiotics to treat another illness. The medication disturbs the bacteria normally found in the gut and allows Clostridium difficile to multiply. It produces poisons (toxins) which can lead to diarrhoea and severe inflammation of the bowel.

Who gets Clostridium difficile?

Clostridium difficile is mostly found in people who are unwell, but it also exists in the gut of a small number of healthy adults. Elderly patients with other underlying diseases are most at risk. More than 80 per cent of cases are in people over 65 years of age. However, infection can occur in anyone who has:

• Been treated with antibiotics
• Undergone gastrointestinal surgery/manipulation
• Had a long stay in a hospital or nursing home
• An immune system which is not working properly

How do you get Clostridium difficile?

Clostridium difficile produces spores that can live in the environment for a long time. Any surface, piece of equipment, furniture or furnishing can harbour the spores. People can become infected by touching contaminated surfaces.

The bacteria are shed in faeces. Touching even the smallest amount of infected faeces, and then touching your mouth you can become infected with Clostridium difficile. The risk of cross-infection increases when patients have diarrhoea and bathrooms and toilets are shared.

Clostridium difficile can be spread from person to person by poor hygiene, by failing to wash your hands properly after going to the toilet, or after handling contaminated food.

How do you avoid getting Clostridium difficile?

You can help to prevent the spread of Clostridium difficile by:

Washing your hands thoroughly with soap and warm water:

• Before preparing and eating food
• After handling raw food
• After going to the toilet or changing a baby's nappy
• after visiting hospitals and care homes

Taking antibiotics only when necessary.

If someone has clostridium, wash all dirty clothes, bedding and towels in the washing machine on the hottest cycle possible. Clean toilet seats, toilet bowls, flush handles, taps and wash hand basins after use with detergent and hot water.

What are the symptoms of Clostridium difficile, and what are the symptoms of Clostridium difficile colitis?

Symptoms of Clostridium difficile include:

• Mild to moderate diarrhoea
• Stomach cramps/tenderness
• Fever
• Loss of appetite
• Nausea

Clostridium difficile colitis is used to describe anyone who has an infection of the colon caused by Clostridium difficile. Colitis means inflammation of the colon, although in some forms the symptoms may be more severe.

What is the treatment for Clostridium difficile?

It is important to drink plenty of fluids as diarrhoea or vomiting can lead to dehydration and you can lose important sugars and minerals from your body. Your doctor may recommend a re-hydration solution, available from your pharmacist.

• If you feel sick, try taking small sips of fluid, frequently.
• Avoid tea, coffee, carbonated drinks or alcohol.
• Always dilute sugary drinks even if you would not normally dilute them.
• A simple painkiller like paracetamol can help combat any pain

If patients develop the infection while taking antibiotics, but do not have colitis only mild diarrhoea, no fever, then stopping the antibiotics, if possible, is often enough to relieve the symptoms.

Clostridium difficile colitis is usually treated with specific antibiotics. It is important that the whole course of antibiotic treatment is completed even if the symptoms disappear. Once the diarrhoea stops it indicates the infection has gone. Occasionally, Clostridium difficile may recur. If this happens, patients should tell their GP.

Do patients who have had Clostridium difficile colitis in hospital need special care once they have returned home?

People who have had Clostridium difficile colitis in hospital do not need special care once they return home. The symptoms of diarrhoea should have gone or their bowels should have started working normally 48 hours before they are discharged from hospital. They may still be taking antibiotics. The normal procedures of routine hand washing, and cleaning of the environment are all that are needed.

Are there any complications?

In severe cases, patients can suffer ulceration and bleeding from the colon (colitis). At worst the intestine tears, so that the spaces in the surrounding abdomen become infected. Although rare, this can be fatal.

Do I need to stay off work or school?

Yes. While you are ill and have symptoms you are infectious. You should not return to work or school until you have been free from diarrhoea for 48 hours.

You should tell your employer you have had Clostridium difficile infection if you work with vulnerable groups such as the elderly, the young, those in poor health, or if you handle food.

The Health Protection Agency and Clostridium difficile

Hospitals have to report all cases of Clostridium difficile to the Agency. We monitor outbreaks and look for any patterns or trends and for any new strains of the bacteria. We also provide advice on how Clostridium difficile can be treated.

More information about Clostridium difficile is available on our website Clostridium difficile

If you have concerns about your health contact NHS Direct on 0845 4647 or visit the website www.nhsdirect.nhs.uk, or see your family doctor.

This factsheet can also be downloaded as a pdf file:  clostridium (PDF, 165 KB)