This spore-forming bacteria occurs naturally in the environment and in the guts of some people. And being treated, particularly with antibiotics, for other illnesses can enable it to grow unencumbered in your colon. Result? Symptoms that are not only uncomfortable but potentially disabling – or even deadly. Check out the video to learn more.
What is C. diff?
- Clostridioides difficile (klos–TRID–e–OY-dees dif–uh–SEEL), or C. diff, is a Gram-positive, spore-forming bacterium or germ.
- C. diff may colonize the human colon. It is present in 2-5% of the population.
- C. diff is found throughout the environment in soil, air, water, human and animal feces, and in contaminated food products.
- This bacterium can lead to an infection in the colon called Clostridioides difficile infection, or CDI.
- Symptoms of CDI may include watery diarrhea (known as Clostridioides difficile-associated diarrhea, or CDAD), fever, nausea, abdominal cramping, dehydration, and loss of appetite.
- C. diff is the most common cause of infectious diarrhea in healthcare settings.
- C. diff caused nearly 500,000 infections in one year, and 29,000 deaths.
- CDI accounts for significant rates of illness and death. In 2011, C. difficile was the 17th leading cause of death for people aged 65 years and older.
- CDI is being increasingly recognized as a cause of diarrhea in the general community and in populations without the traditional risk factors for CDI
- CDI recurs in about 1 in 5 patients
- Current or recent antibiotic use. Taking antibiotics increases the risk for acquiring a CDI by 7 – 10 times
- Being aged 65 or older
- Admission to the hospital for more than 8 hours, especially if admitted through the hospital emergency room
- Admission to the intensive care unit
- Residency in a nursing home
- Other risk factors include using antacids and gastrointestinal surgery
- Learn more about how it can be diagnosed here.
If you suspect you or a loved one has a CDI, please visit our Treatment Options page.
- Only take antibiotics as prescribed by your doctor when absolutely needed for an infection.
- You can help prevent the spread of C. diff in many ways, including thoroughly washing your hands, using bleach-based cleaners, and using prescriptions exactly as directed.
- Learn more by downloading our Care Guide.
Patients and their families seek healthcare to prevent and cure illness. But every year, hundreds of thousands of Americans seeking relief from an illness or injury are exposed to a healthcare-associated infection (HAI). Over the past few years, our healthcare system has made progress in minimizing harm from many HAIs, such as MRSA and central line infections. Still, Clostridioides difficile infections (CDIs) have been increasing in the United States every year since 2000.
CDI can affect ANYONE
- While the elderly and people with compromised immune systems are more vulnerable to CDIs, the primary risk factor is current or recent use of antibiotics, particularly those in these classes.
- Clindamycin (Brand name Cipromycin®)
- Fluoroquinolones (Levaquim®)
- Cephalosporins, such as cefalexin (Keflex® and Daxbia®)
- CDI is the most common cause of infectious diarrhea in healthcare settings.
- Taking antibiotics increases the risk for acquiring a CDI by 7 – 10 times
- Other risk factors include being aged 65 or older and having recently stayed in a healthcare facility.
- In recent years, postpartum women and healthy adults have seen increased risk for CDI.
- An estimated 20,000 children get a CDI every year, according to a 2023 study in the Journal of Pediatrics. The Pediatrics study found no difference in the incidence of CDI among boys and girls and that the highest numbers were seen in white children and those between the ages of 12 and 23 months.
- In 2009, there were 336,600 hospital stays related to CDI—an increase of 126% from 2001.
- There are nearly 500,000 C. diff infections annually in the US.
- CDI recurs in about 1 in 5 patients.
- CDI significantly impairs patients’ quality of life both physically and emotionally because of the lack of control of bowel function and lack of understanding about the illness.
- CDI, particularly the nature of the diarrhea, negatively affects patients’ relationships with family, children and spouses.
- Most patients with CDIs describe themselves as “housebound.”
- 29,000 Americans died from a CDI in 2011.
- In 2011, CDI was the 17th leading cause of death for people aged 65 years and older.
- 2011 death rates related to CDI were ten times higher than those in 1999.
- Nursing home CDI cases alone led to 9,000 deaths in 2011.
- Costs include up to $6.2 billion in aggregated annual costs for hospital care of patients with CDI
- The average cost per hospital stay for patients with CDI is $24,400, more than triple the cost (~$8,000) for other patients
- On average, CDI increases hospital stays by 3.3 days
- There are also indirect costs of CDI, including days lost due to absence, productivity losses, and hiring others to help with daily home tasks
CDI has LASTING effects
- Severe CDI cases can lead to colectomy (surgical removal of the colon), which has long term effects on a patient’s health and lifestyle.
- A small percentage of CDI sufferers report post-infectious irritable bowel syndrome for several months.
- Many CDI sufferers report fear and anxiety of recurrence after cure.
- Patients also reported being afraid of taking antibiotics because of risk of recurrence as well as increased concern about hand hygiene and cleaning surfaces.
- Even after recovery, many CDI survivors still harbor trauma of their past experience, particularly around cleanliness of themselves and their environment.
While Clostridioides difficile infections (CDIs) have been skyrocketing over the past few years, examples from other countries and research done throughout the US demonstrate that change is possible. Peggy Lillis Foundation urges physicians, policymakers and citizens to take the following strategies and actions to reduce CDIs.
Increase Rapid Diagnosis and Treatment of CDI patients
- Doctors can ensure people with CDIs are diagnosed quickly by ordering a C. diff test if the patient has had three or more unformed stools.
- Doctors can keep up to date with new and emerging treatments for patients with CDI.
- Doctors can ensure people with recurrent CDI have access to microbiome restoration therapies.
- Patients and caregivers can monitor CDI symptoms, particularly among populations known to be at risk (e.g., the elderly and immuno-suppressed).
- Healthcare executives and administrators can raise awareness of CDI risk factors to ensure state-of-the-art diagnostics and treatments are available to their patients.
Decrease Overuse and Misuse of Antibiotics
- An estimated 50% of antibiotics prescribed for outpatients are unnecessary, or ineffective because the patient has a virus.
- Eliminate medically necessary antibiotics from use in farm animals. Nearly 80% of all antibiotics sold in the US are used for growth promotion in farm animals.
- Patients can take antibiotics only as prescribed by your doctor and complete the prescribed course.
- Patients can request a narrow spectrum antibiotic for most common infections. Learn more about when antibiotics are and aren’t needed for common infections.
- Patients can stop insisting on an antibiotic for viral infections.
- Physicians can prescribe and use antibiotics carefully. Once culture results are available, check whether the prescribed antibiotics are correct and necessary.
Increase Sanitation and Hand Hygiene
- Early results from hospital prevention projects show the 20% fewer CDIs in less than 2 years with the implementation of correct infection prevention and control measure.
- Health care executives and administrators assess hospital cleaning to be sure it is performed thoroughly and augment this using an Environmental Protection Agency-approved, spore-killing disinfectant in rooms where CDI patients are treated. Click here for a list of EPA approved products known to kill C. diff bacteria.
- Hand washing compliance remains poor among doctors, who practiced it only 60% of the time, and nurses (71% of the time), according to the World Health Organization.
- Healthcare workers can wear gloves and gowns when treating patients with CDI, even during short visits.
- Hand sanitizer does not kill C. difficile, and although hand washing works better, it still may not be sufficient alone, thus the importance of gloves.
- By focusing on hand hygiene, Cleveland’s MetroHealth System reduced infections from 35% – 71% and saved the hospital $5.3 million in excess costs from 2010-2014.
Increase Reporting and Surveillance
- While the Centers for Disease Control has national surveillance programs for CDI, only 20 states mandate reporting of the disease and fewer make that data public.
- Increased reporting and surveillance will enable public health officials to capture true CDI burden in their state and help patients and consumers make informed choices about where to receive healthcare.
- States and communities can encourage health care facilities to track and share data using CDC’s National Healthcare Safety Network.
- States and communities can develop regional CDI prevention projects with many types of facilities. New York, Illinois, and Massachusetts have all reduced CDIs through multi-hospital regional collaborations.
- States and communities can expand reporting and surveillance beyond acute care hospitals to nursing homes, rehabilitation centers, and other health care facilities.
Increase Awareness and Bust Myths
- Physicians can warn their patients about the relative risk of CDI when prescribing antibiotics, antacids, scheduling surgery, during hospital admission, and other events that can precipitate CDI.
- People who’ve had a CDI or a lost a loved one it can take an array of actions to raise awareness of the epidemic by visiting our Take Action page.
- CDI survivors can share their stories to help us show the human impact of the disease.
- Physicians and health care workers can read and share our C. diff Myths page.