Clostridioides difficile infection

Also called C. diff, C. difficile, Pseudomembranous colitis

Diarrhoea caused by the antibiotics given for something else. Alcohol gel does not kill it, and that single fact explains most outbreaks.

What it is

An infection of the bowel by Clostridioides difficile, a bacterium that a proportion of people carry harmlessly. Antibiotics wipe out the competing gut bacteria, C. difficile multiplies, and it releases toxins that inflame the bowel.

It is above all a hospital and care home problem, and it mostly affects older people who have recently had antibiotics. It can be severe: it causes dehydration, a dangerously distended bowel, perforation, and death.

Two practical facts matter more than the biology. First, it forms spores that survive on surfaces for months and are **not killed by alcohol hand gel**. Soap and water washing, and chlorine-based cleaning, are what work. A ward relying on gel alone will keep spreading it.

Second, it recurs. Around one in five people get it again after treatment, and each recurrence makes the next more likely. Faecal microbiota transplant is now recommended for people with repeated recurrences and is genuinely effective, though not widely known.

Prevention is antibiotic stewardship: not prescribing what is not needed, and using narrow-spectrum drugs where possible.

Signs you might notice

Watery diarrhoea, three or more times a day, usually starting during or within weeks of an antibiotic course.

A characteristic offensive smell that experienced staff recognise.

Abdominal pain and cramping, fever, loss of appetite, nausea.

Severe disease: a swollen, tender abdomen; diarrhoea that stops in someone who is getting worse, which can mean the bowel has stopped moving; confusion; a very high or low temperature; a fast heart rate.

Urgent, same day: blood in the stool, severe abdominal pain, a distended abdomen, signs of dehydration, or any sign of sepsis.

In an older person, delirium may be the first thing anybody notices.

How it can affect day-to-day life

The dignity cost is severe and under-discussed. Frequent urgent diarrhoea, isolation in a side room, staff in aprons and gloves, and visitors discouraged, all at once, in someone already unwell.

Isolation itself causes harm: less mobility, less food, less contact, more delirium. It is necessary and it needs actively offsetting.

Skin breaks down fast with frequent liquid stool. Barrier protection and prompt cleaning prevent damage that otherwise takes months to heal. See pressure ulcers and wound care.

Anti-diarrhoeal medicines such as loperamide should not be used: they trap toxin in the bowel.

Families are often frightened and blamed by turns. Being clear that this is a recognised complication of necessary treatment, not neglect by anybody in the room, helps.

Supporting someone well

Wash hands with soap and water. Alcohol gel does not kill the spores, and this is the most commonly missed point in the whole entry.

Clean with a chlorine-based product, including toilets, commodes, handles and rails.

Isolate promptly and review the isolation daily for its own harms.

Stop the causative antibiotic where possible and ask whether any current antibiotic is still needed.

Do not give loperamide.

Keep fluids up and watch for dehydration; weigh and record stool frequency, which is what tells the team whether it is settling.

Protect the skin from the first episode, not after it breaks down.

For a second or third recurrence, ask specifically about faecal microbiota transplant. Many clinicians do not raise it.

Where to get help

A GP practice or the ward team; specimens are needed to confirm it.

Same-day assessment for severe pain, blood, a distended abdomen or signs of sepsis.

Guts UK publish clear information on gut infections and recovery.

UK Sepsis Trust for the sepsis warning signs.