The Clostridioides difficile bacteria are found in stool (fecal matter), and spread from person to person through direct and indirect contact.

Not everyone who has the bacteria becomes ill, however. It is possible to spread the infection unknowingly.

Direct contact: Someone who has the bacteria on their hands touches someone else, transferring the germs to the other person.

Indirect contact: The bacteria can stay alive for quite a while on surfaces, such as bedside tables, elevator buttons, doorknobs, telephones, and even clothing. People with the bacteria on their hands touch these objects. Others then touch them, transferring the bacteria to their own hands.

• Watery diarrhea (at least three bowel movements per day for two or more days). Diarrhea caused by C. difficile has as particular odor.
• Fever
• Decrease or loss of appetite
• Nausea
• Abdominal pain, bloating, tenderness.

If the infection progresses and becomes more severe, there may also be:

• Dehydration
• Weight loss

People who are in hospitals or other healthcare settings are at highest risk of developing C. difficile infections. Others are those who:

• Are over 65 years
• Have serious illnesses, particularly those that can weaken the immune system
• Are taking or who have recently taken antibiotics
• Are taking medications to manage stomach acid, including those known as proton pump inhibitors (PPIs)
• Have had previous C. difficile infections.

The only way to prevent developing an infection with C. difficile is by avoiding exposure to the bacteria. The most effective method to do this is by frequent and proper hand washing with soap and water by everyone: patients, visitors, and anyone who works in the healthcare facilities. Waterless hand cleaners do not adequately kill C. difficile.

Patients who have C. difficile infection should be isolated from other patients to avoid spreading the bacteria. Healthcare workers who enter isolation rooms have to wear gloves and gowns.

Reducing antibiotic overuse also reduces the risk of C. difficile infection. This means not asking for antibiotics for viral infections (like colds and the flu) and not taking someone else’s medications.

Doctors use specific antibiotics to treat C. difficile, but recommendations vary according to the severity of the infection, how often a patient has had the infection, and the availability of the recommended antibiotics. There are also newer treatments such as those that involve transplanting healthy fecal matter into the infected person’s gut. To learn about the most up-to-date research into treatments, visit the CDC page on C. diff.

In severe cases, a surgeon may need to remove the affected part of the colon.

The CDC reports that about 20% of people experience a recurrence of C. difficile infection, sometimes repeatedly. However, testing with FMT is showing a high success rate in eliminating the infection altogether.