Colitis Caused by Clostridium difficile (C. diff)

Clostridium difficile (C. diff) causes a spectrum of bacterial diseases in the colon. You may have the bacteria but have no symptoms. Or, you could experience symptoms ranging from mild diarrhea to the more serious, sometimes life-threatening colitis (inflammation of the colon).

Many people who are infected with Clostridium difficile will not get sick. However, it is important to remember that you can potentially spread the disease without knowing it. People who are most likely to get sick are those that are hospitalized or taking antibiotics.

Image of Clostridium difficile

How It Spreads

The disease occurs when someone who has been taking antibiotics or has certain medical conditions gets infected by the bacteria. This usually happens when they transfer the bacteria from feces-contaminated items or surfaces to their mouth or nose.

Clostridium difficile is a hardy microbe that can form spores that survive in the environment for months. In hospital settings, spores spread from patient-to-patient, as well as from hospital staff to patient.

How It Causes Disease

Treatment of bacterial diseases with antibiotics can simultaneously kill the resident bacteria, also called “microflora,” living in your colon. The microflora normally protects your colon, but in its absence, other infectious microbes, such as Clostridium difficile (which is more resistant to most antibiotics than typical microflora bacteria) can take their place and cause disease.

Clostridium difficile produces toxins that cause diarrhea by damaging cells in the colon, leading to the formation of ulcers (sores) in the colon. The toxins lead to severe inflammation, and the resultant dead cells and mucus can form a “pseudomembrane,” which is characteristic of the disease.

In 2006, a new strain of Clostridium difficile called NAP1, which produces 20 times more toxins than other strains, was found to be responsible for colon diseases of increased severity and mortality. In November 2008, the potentially deadly NAP1 strain was reported to be up to 20 times more common than previously thought. (The strain may be responsible for outbreaks dating back to 2000.)

Who's at Risk

All people can get infected, but people who have been taking antibiotics or are hospitalized are at risk of getting a severe disease. Other factors that increase the risk for Clostridium difficile disease include longer hospital stay, age greater than 65 years, severe underlying disease, and living in long-term care facilities. Newborns are less likely to get the disease because they aren’t affected by the Clostridium difficile toxins.

Symptoms and Signs

The primary symptom is watery diarrhea, three or more times per day for at least two days. Other symptoms include fever, nausea, loss of appetite, and abdominal pain.


Several tests are available for Clostridium difficile, including those that detect specific toxins in stool samples and bacterial cultures for the microbe. A large jump in white blood cell count can also be a sign.


Ten-day use of antibiotics, such as oral vancomycin or metronidazole, is recommended. However, since infection can be caused by the use of another antibiotic in the first place, one may need to stay on the prescribed medication longer.

A promising experimental treatment, called fecal bacteriotherapy, involves a transfer of fecal material from a healthy donor to reverse the bacterial imbalance in the intestines. The healthy microbiome has been somewhat wiped out by antibiotics and as such C Diff can flourish; a fecal transplant lets a new microbiome be planted.

Prognosis and Complications

Most people who get Clostridium difficile disease will have mild to moderate diarrhea. Severe disease, such as colitis, can occur and require treatment. Without treatment, colitis can develop into more serious diseases, such as fulminant colitis, which requires immediate surgical consultation.


Because Clostridium difficile disease primarily occurs after antibiotic use, it is important to restrict the use of antibiotics to the treatment of diseases in which they are essential. In addition, frequent hand washing and environmental disinfection should be practiced. Alcohol-based hand disinfection does not eliminate C. diff spores, so hand washing is absolutely essential.

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Article Sources
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  1. Clostridium Difficile Infection | C. difficile. MedlinePlus. Sept 13, 2019.

  2. Hassoun A. Clostridium difficile associated disease. BMJ. 2018;363:k4369. doi:10.1136/bmj.k4369

  3. Farooq PD, Urrunaga NH, Tang DM, Rosenvinge ECV. Pseudomembranous colitis. Disease-a-Month. 2015;61(5):181-206. doi:10.1016/j.disamonth.2015.01.006

  4. Kuiper GA, Van prehn J, Ang W, Kneepkens F, Van der schoor S, De meij T. Infections in young infants: Case presentations and literature review. IDCases. 2017;10:7-11. doi:10.1016/j.idcr.2017.07.005

  5. Van der wilden GM, Chang Y, Cropano C, et al. Fulminant Clostridium difficile colitis: prospective development of a risk scoring system. J Trauma Acute Care Surg. 2014;76(2):424-30. doi:10.1097/TA.0000000000000105

  6. WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care. Geneva: World Health Organization; 2009.

Additional Reading
  • General Information about Clostridium difficile Infections. Centers for Disease Control and Prevention.

  • National U.S. Inpatient Healthcare Facility Clostridium difficile Survey. APIC Research Foundation.

  • Salyers AA and Whitt DD. Bacterial Pathogenesis: A Molecular Approach. ©1994, American Society for Microbiology, Washington, DC. pp. 282-289.

  • Sunenshine RH and McDonald LC. Clostridium difficile-associated disease: New challenges from an established pathogen. Cleveland Clinic Journal of Medicine. 2006; 73:187.