How to Prevent C. Diff Infection From Recurring

Clostridioides difficile infection, often referred to as  C. diff, is a bacterial infection in the digestive system.

C. diff is a highly infectious bacterium that can cause a range of symptoms, most commonly diarrhea—or loose stools—cramping, indigestion, stomach upset, and bloating.

C. diff infections usually are transmitted through healthcare settings such as in hospitals and nursing facilities. C. diff infections are often linked to the recent use of antibiotics. Antibiotic drugs kill bacteria and can, therefore, disrupt the balance of normal bacteria that live in the digestive system.  Recurrence of C. diff infection is common, with around 10% to 20% of people experiencing a repeat infection.

Learn about the most common reasons for recurrence and how to manage a C. diff reinfection below.  

How Common Is Recurrence?

Recurrence of infection—or reinfection—is common with C. diff infection. If you are reinfected, it can be with the same strain of C. diff you had before or a completely new strain. The rate of recurrence is estimated to be between 10% and 20% of all C. diff infections.

This means that after treatment, there is a chance that you can experience reinfection, though it is not the most likely outcome. The recurrence rate goes up with subsequent episodes: up to 20% to 25% after the first episode, 40% to 45% after the second episode, and more than 60% to 65% after three or more episodes of C. diff.

The most common risk factors for reinfection with C. diff are antibiotic usage and older age.

Once you have a C. diff infection, you may continue to have some detectable level of C. diff bacteria that live within the gut, which may never completely go away. This is called colonization and describes that C. diff is now a part of the normal microbial population in your gut. However, this does not mean that you will have symptoms all the time.

Colonized C. diff bacteria can live naturally within your digestive system without causing problems or symptoms of C. diff infection.

However, in some cases, the bacteria can be triggered to reproduce and multiply. The reproducing C. diff bacteria can overwhelm the digestive system and cause a recurrence of a C. diff infection. The exact reason for this overpopulation is not known, but it usually occurs after antibiotics kill of other bacteria in the gut. It may also result from changes in the immune system that weaken it, as from having cancer or human immunodeficiency virus (HIV), or taking immunosuppressive therapies.

Comprehensive medical treatment can resolve the illness associated with a C. diff infection.

Can I Still Spread C. Diff After Treatment?

After you complete  a full course of treatment with antibiotics your risk of transmitting C. diff is low but not zero. You can still spread the disease to others even if you are not symptomatic. However, proper hygiene practices like washing your hands frequently with soap and water after using the bathroom will reduce the chance of spread.

Even if you are not actively spreading C. diff, there is still a possibility that C. diff reinfection can occur. This can be from the same C. diff you had previously or, in some cases, from a new strain.

What if I Get C. Diff Again?

You may notice C. diff infection has come back if you have:

• Increased watery or runny bowel movements
• Abdominal cramping
• Indigestion

Other symptoms of C. diff—such as vomiting, nausea, or fever—are additional signs of a possible reinfection.

Treatments for recurrence of C. diff infection can include:

• Dificid (fidaxomicin)
• Vancocin (vancomycin)
• Flagyl (metronidazole)
• Alinia (nitazoxanide)
• Bezlotoxumab (zinplava)
  
• Fecal microbiota transplantation (FMT)
  

Repeated infections with C. diff may result in the development of antibiotic resistance. This can lead to the C. diff bacteria becoming resistant to antibiotic drugs such as vancomycin and fidaxomicin.

In cases of ongoing and repeated infections with C. diff, your healthcare team may recommend a procedure known as a fecal microbiota transplant, which replaces your microbiome with other bacteria from a donor after a careful screening of the donor sample.

The procedure involves a colonoscopy, in which a healthcare provider visualizes the colon with a small camera and then transfers stool from a donor directly into your colon. FMT can also be delivered through the upper GI tract via capsule ingestion, using a nasoduodenal tube or by performing an upper endoscopy (EGD). The efficacy of FMT delivered via colonoscopy is slightly higher than FMT delivered through the upper GI route (93% vs. 81% to 83%).

In November 2022, the FDA approved Rebyota, the first fecal microbiota product. Rebyota is approved for the prevention of the recurrence of C. diff infections in adults who have completed antibiotic treatment for recurrent C. diff infections.

FMT has been proven effective in treating frequent C. diff infections. FMT can also be used to treat C. diff infections that are not responsive to antibiotics. If you are experiencing frequent reinfections with C. diff, consult with your healthcare team about whether FMT may be right for you.

Summary

C. diff, is a bacterial infection in the digestive system. Recurrence is common, with around 10% to 20% of people experiencing a repeat infection.

A Word From Verywell

C. diff recurrence is a common issue after a first C. diff infection. It can be discouraging to have the same problem happen again, but know that you are not to blame. Reinfection can be random and there is no way to predict or completely prevent recurrence of C. diff. If you have recurrence of C. diff there are treatment options available including medications and procedures.