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Community Clostridioides difficile (C. diff)

This information leaflet is to help you to understand Clostridioides difficile, what it is and what can be done to prevent it.

What is Clostridioides difficile (C. diff)?

Many different bacteria (germs) live in the normal healthy bowel. Clostridioides difficile (also known as C. diff) is a bacterium that is present in the bowel of nearly 3% of healthy adults in the general population.  It does not usually cause any harm or symptoms, but if the number of bacteria increases it can cause diarrhoea.

Symptoms of a C. diff infection

  • Explosive watery and smelly diarrhoea which can be bloody and develop suddenly.
  • Painful tummy cramps.
  • Feeling sick.
  • Loss of appetite and weight loss.
  • Fever above 380C (100.4 0F).
  • Signs of dehydration such as a dry mouth, headaches and passing urine less often than normal.

Visiting your General Practitioner (GP) surgery with a possible C. diff infection can put others at risk. So, it is best to call your GP or NHS 111 if you are concerned or feel you need advice.

How do you know if you have a C. diff infection?

Your GP may suggest sending off a sample of diarrhoea to confirm whether you have C. diff. A blood test may also be carried out to help determine how severe the infection is, and sometimes you may need tests or scans in hospital to check if your bowel is damaged.

How do people get it?

Some antibiotics can interfere with the balance of bacteria in the bowel. This can cause the normal healthy bacteria to be reduced allowing C. diff bacteria to multiply, increase in number and produce toxins. This can lead to diarrhoea.

Who is most at risk of C. diff?

C. diff most 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 those taking long-term antibiotics).
  • Have been a resident in a health-care setting, such as a hospital or care home for a long time.
  • Are over 65 years of age.
  • Have certain underlying conditions, including inflammatory bowel disease (Crohn’s, Ulcerative colitis), cancer or kidney disease.
  • Have a weakened immune system, which can be because of a condition such as diabetes, or a side effect of treatment such as chemotherapy or steroid medication.
  • Are taking a medication called a Proton Pump Inhibitor (PPI) e.g., Lansoprazole to reduce the amount of stomach acid they produce.
  • Have had surgery on their stomach and/or bowel.
  • A previous history of C. diff

Treatment for a C. diff infection

Your GP will decide whether you need any treatment depending on the severity of your symptoms.

Treatment for C. diff can include:

  • Stopping the antibiotics thought to be causing the infection, if possible – in mild cases, this maybe the only treatment that is needed.
  • Taking a 10-to-14-day course of antibiotics that re known to kill C. diff bacteria.
  • In more severe cases serious C. diff infections may require surgery to remove a damaged section of the bowel.

C. diff infections usually respond well to treatment with most people making 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.

Once free from diarrhoea for 48 hours with a formed stool being passed or normal bowel habit has resumed you are considered non-infectious to others.

Recurrent CDI infection  

Around 1 in 4 people who get C.difficile infection will get CDI again. 

A further episode of CDI within 12 weeks of symptom resolution is called a ‘relapse’ of CDI.

A further episode more than 12 weeks after symptom resolution is called a ‘recurrence’.

The risk of recurrence increases with every subsequent infection.

Recurrent infection may be caused by the same strain of bacteria as your previous infection or by reinfection with a different strain. 

Recurrent infection can be associated with a contaminated environment, poor hand washing or from the CDI spores in the bowel become becoming active again. The most common cause of recurrent CDI is further antibiotic use so antibiotics should only be used if absolutely necessary.  

Treatment options

Further treatment options available to you include:

  • A course of medication called Fidaxomicin which is taken twice a day for 10 days.
  • A longer (+/- higher dose) course of medication called Vancomycin.
  • Faecal Microbial Transplantation (FMT). This is which is recommended if you have had 2 or more episodes of recurrent CDI as it has been shown to greatly reduce the risk of further recurrent CDI compared to Vancomycin and / or Fidaxomycin.

Please refer to leaflet on FMT for further information and discuss with your healthcare provider.

Looking after yourself at home

 The following measures can help relieve your symptoms and prevent the infection spreading:

  • Make sure you finish the entire course of the antibiotics prescribed for your C. diff, even if you’re feeling better.
  • If you have diarrhoea, this can sometimes make you feel unwell and make you less inclined to eat. You may also be afraid to eat or drink too much in case it makes your diarrhoea worse (please see page 4 dietary advice).
  • Take paracetamol for tummy pain or a fever.
  • Don’t take anti diarrhoeal medication (e.g., Imodium), as this can stop the infection being cleared from your body.
  • Regularly wash your hands with soap and water, particularly after going to the toilet and before eating – use liquid rather than bar soap and don’t use flannels or nail brushes.
  • Do not use alcohol hand gels as they are not effective against C. diff.
  • Clean contaminated surfaces – such as the toilet flush handle/button, light switches and door handles with a bleach-based cleaner after each use (e.g., Milton).
  • Surfaces where food is prepared should be thoroughly cleaned using a bleach-based product, both before and after food preparation.
  • Don’t share towels or toothbrushes.
  • Wash contaminated clothes and sheets separately from other washing at the highest possible temperature using a biological washing powder.
  • Should floors or surfaces become soiled with faeces, these must be cleaned immediately using a disposable cloth and detergent, then disinfected with a bleach-based cleaning product (except soft furnishings). It is also advisable to re-clean the surface a second time to destroy any residual bacteria.
  • If disposable cloths are not available reusable cloths must be washed at a very high temperature (600 C) using biological soap powder.
  • General household cleanliness is also very important. Surfaces such as telephones, door handles, and bedside tables should be cleaned daily with household bleach based cleaner. Carpets and floor should be vacuumed daily. Vacuum bags and cylinders should be emptied /changed on a more regular basis and hands cleaned with liquid soap and water following this.
  • Carers should also practice good hand hygiene using liquid soap and water. This is especially important after contact with infected persons or surfaces within their immediate environment.
  • Avoid visiting hospital if you’re feeling unwell or have recently had diarrhoea.
  • Stay at home until at least 48 hours after your last episode of diarrhoea.

Can I have visitors?

Yes, you can have visitors. Your relatives and friends should wash their hands with liquid soap and water on entry and leaving your home. Your visitors are more vulnerable to this infection if they are taking antibiotics themselves.

Dietary Advice

This leaflet will help you choose appropriate meals, snacks, and drinks to help you stay as well as possible.

What can I drink?

When your symptoms are at their worst, try to keep drinking to avoid dehydration. Try to have 10-15 cups of fluid per day. Choose any drink that you prefer.  Suitable choices can include:

  • Water
  • Fizzy drinks
  • Beef drinks
  • Decaffeinated coffee
  • Squash
  • Clear soups
  • Tea
  • Fruit tea

Sugar or honey can be added to drinks to add calories. Fresh fruit juices should be diluted with the same volume of water, tonic, lemonade, or soda water. This is because they can make diarrhoea worse if drunk when concentrated. However, they are a good source of vitamin C so should still be part of your diet. Milk and milky drinks are a valuable source of nutrition and can be introduced into your diet.

What can I eat?

When your appetite allows, soft easy to eat foods can be included, such as:

  • White bread or toast
  • Plain biscuits
  • Tender meats
  • Sorbet
  • Milk puddings
  • Mashed potato
  • White fish
  • Jelly
  • Yoghurt
  • Ice cream

Root vegetables, such as carrots, parsnips, beetroot and swede, and stewed fruit are good choices.

What foods and drinks should I avoid?

Foods that may irritate the bowel such as alcohol, spicy food and greasy food are best avoided.

Foods that contain a lot of fibre such as wholegrain cereals, wholemeal bread, fibrous fruits, vegetables, and pulses should also be avoided.

Glucose drinks are too concentrated and can also have a laxative effect. These should also be diluted with water or lemonade. However, isotonic sports drinks are suitable as they are the correct strength.

What about probiotics?

You may have heard that pro-biotic drinks, yoghurts, and supplements may help to treat your diarrhoea. There is no conclusive evidence to support this however, if you are already taking these products, it will not harm you to continue.

Contact with Infection Prevention Team

Anyone who has been diagnosed with a C. diff infection will be given the opportunity to discuss their concerns with a member of the Infection Prevention Team. Your GP practice may ask you if you consent to the Infection Prevention Team contacting you to discuss your result, current symptoms, treatment, and practical advice if required.

If you require any further information or need to speak to someone, please call 0191 4458435.