{"id":60315,"date":"2025-07-29T11:56:28","date_gmt":"2025-07-29T11:56:28","guid":{"rendered":"https:\/\/cdhf.staging.not4prod.com\/?post_type=digestive-condition&#038;p=60315"},"modified":"2026-10-28T21:57:23","modified_gmt":"2026-10-28T21:57:23","slug":"clostridiodes-difficile-c-difficile-infection","status":"publish","type":"digestive-condition","link":"https:\/\/cdhf.ca\/en\/digestive-conditions\/clostridiodes-difficile-c-difficile-infection\/","title":{"rendered":"Clostridiodes Difficile (C. difficile) Infection"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><em>C. difficile<\/em> is a common infection  Learn what it is, and how to recognize symptoms early. <\/p>\n\n\n<div class=\"wp-block-ub-content-toggle wp-block-ub-content-toggle-block\" id=\"ub-content-toggle-block-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" data-mobilecollapse=\"false\" data-desktopcollapse=\"true\" data-preventcollapse=\"false\" data-showonlyone=\"true\">\n<div class=\"wp-block-ub-content-toggle-accordion\" style=\"border-color: #ffffff; \" id=\"ub-content-toggle-panel-block-\">\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-title-wrap\" style=\"background-color: #ffffff;\" aria-controls=\"ub-content-toggle-panel-0-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" tabindex=\"0\">\n\t\t\t<h2 class=\"wp-block-ub-content-toggle-accordion-title ub-content-toggle-title-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" style=\"color: #1f1f1f; \">What is <em>Clostridioides difficile (C. difficile)<\/em>?<\/h2>\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-toggle-wrap right\" style=\"color: #e32f68;\"><span class=\"wp-block-ub-content-toggle-accordion-state-indicator wp-block-ub-chevron-down\"><\/span><\/div>\n\t\t<\/div>\n\t\t\t<div role=\"region\" aria-expanded=\"false\" class=\"wp-block-ub-content-toggle-accordion-content-wrap ub-hide\" id=\"ub-content-toggle-panel-0-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\">\n\n<p class=\"wp-block-paragraph\">Previously known as <em>Clostridium difficile, <\/em><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431054\/\"><em>Clostridioides difficile<\/em><\/a><em> (C. difficile) <\/em>is a bacterium that produces toxins leading to diarrhea and inflammation of the colon.\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">While <em>C. difficile<\/em> was once considered an infection contracted in healthcare settings, such as hospitals and long-term care facilities, it&#8217;s increasingly being diagnosed in community settings. This is primarily due to the emergence of a new strain, known as North American pulsed-field gel electrophoresis type 1 (or NAP1), which is more infectious and resistant to fluoroquinolone antibiotics. The arrival of this new strain has led to an increase in both frequency and severity of <em>C. difficile <\/em>infections over the past 20 years.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What causes <em>C. difficile <\/em>infections?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><em>C. difficile <\/em>is a spore-forming bacterium. This means it can survive on surfaces for an extended period. Since <em>C. difficile <\/em>bacteria and spores are <a href=\"https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/fact-sheet-clostridium-difficile-difficile.html\">found in feces<\/a>, people who touch contaminated surfaces and then touch their mouths are at risk of contracting an infection. Once <em>C. difficile <\/em>is able to proliferate in the colon, it produces toxins that are key factors in the development of colon inflammation (colitis) and <a href=\"https:\/\/cdhf.ca\/en\/digestive-conditions\/diarrhea\/\">diarrhea<\/a>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Who is at risk of <em>C. difficile <\/em>infections?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">People who have taken <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431054\/\">broad-spectrum antibiotics<\/a>, such as penicillins, cephalosporins, fluoroquinolones, and clindamycin, are at an increased risk of developing a <em>C. difficile <\/em>infection. This happens because antibiotics disrupt the balance of the gut microbiota (the community of trillions of microorganisms living in the gut). When a person takes antibiotics, beneficial bacteria that were previously preventing <em>C. difficile <\/em>from growing may be killed. This opens the door for <em>C. difficile<\/em> to proliferate, leading to infection.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Other risk factors for developing a <em>C. difficile <\/em>infection include:\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Taking proton pump inhibitors (PPIs, used to treat conditions like acid reflux).<\/li>\n\n\n\n<li>Having a suppressed immune system (such as people undergoing cancer chemotherapy).<\/li>\n\n\n\n<li>Having other underlying medical conditions.<\/li>\n\n\n\n<li>Have had a <em>C. difficile <\/em>infection in the past.<\/li>\n\n\n\n<li>Kidney or liver failure.<\/li>\n\n\n\n<li>Recent or prolonged hospital stays.<\/li>\n\n\n\n<li>People who work in healthcare settings.<\/li>\n\n\n\n<li>Elderly people.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">What is recurrent <em>C. difficile <\/em>infection?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">While most people who receive treatment for <em>C. diff <\/em>get better, about <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/c-difficile\/diagnosis-treatment\/drc-20351697\">25%<\/a> of people develop a relapse and return of symptoms within 2 months. This is known as recurrent <em>C. difficile <\/em>infection(recurrent C. diff). The risk of recurrent C. diff increases with each subsequent infection, and over 50% of people who have had three infections will experience another recurrent infection. The risk of recurrent C. diff remains elevated until the patient&#8217;s intestinal microbiota is recovered.<\/p>\n\n<\/div>\n\t\t<\/div>\n\n<div class=\"wp-block-ub-content-toggle-accordion\" style=\"border-color: #ffffff; \" id=\"ub-content-toggle-panel-block-\">\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-title-wrap\" style=\"background-color: #ffffff;\" aria-controls=\"ub-content-toggle-panel-1-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" tabindex=\"0\">\n\t\t\t<h2 class=\"wp-block-ub-content-toggle-accordion-title ub-content-toggle-title-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" style=\"color: #1f1f1f; \">Signs and Symptoms<\/h2>\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-toggle-wrap right\" style=\"color: #e32f68;\"><span class=\"wp-block-ub-content-toggle-accordion-state-indicator wp-block-ub-chevron-down\"><\/span><\/div>\n\t\t<\/div>\n\t\t\t<div role=\"region\" aria-expanded=\"false\" class=\"wp-block-ub-content-toggle-accordion-content-wrap ub-hide\" id=\"ub-content-toggle-panel-1-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\">\n\n<p class=\"wp-block-paragraph\">Symptoms of <em>C. difficile <\/em>can vary. Some people are asymptomatic carriers, meaning the bacteria or spores are present in their colon but do not cause any symptoms.\u00a0<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Some of the most common <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431054\/\">symptoms<\/a> associated with a symptomatic <em>C. difficile <\/em>infection include:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Watery <a href=\"https:\/\/cdhf.ca\/en\/digestive-conditions\/diarrhea\/\">diarrhea<\/a>, sometimes with mucus or blood in it<\/li>\n\n\n\n<li>Loss of appetite<\/li>\n\n\n\n<li>Nausea<\/li>\n\n\n\n<li>Vomiting<\/li>\n\n\n\n<li>Mild fever<\/li>\n\n\n\n<li>Abdominal pain<\/li>\n\n\n\n<li>Abdominal distention<\/li>\n\n\n\n<li>Hypovolemia (when your body doesn&#8217;t have enough blood or fluid, which can lead to low blood pressure and not enough oxygen getting to your organs)<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Some people also experience non-GI symptoms such as reactive arthritis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Risks of untreated <em>C. difficile<\/em><strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Untreated <em>C. difficile <\/em>infections can cause significant <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431054\/\">damage to the colon<\/a>, resulting in:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Toxic megacolon (a rare but life-threatening condition where the colon becomes extremely swollen and inflamed).<\/li>\n\n\n\n<li>Bowel perforation with peritonitis (an infection in the lining of your abdomen).<\/li>\n\n\n\n<li>Sepsis (which can lead to organ failure and even death).<\/li>\n<\/ul>\n\n<\/div>\n\t\t<\/div>\n\n<div class=\"wp-block-ub-content-toggle-accordion\" style=\"border-color: #ffffff; \" id=\"ub-content-toggle-panel-block-\">\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-title-wrap\" style=\"background-color: #ffffff;\" aria-controls=\"ub-content-toggle-panel-2-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" tabindex=\"0\">\n\t\t\t<h2 class=\"wp-block-ub-content-toggle-accordion-title ub-content-toggle-title-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" style=\"color: #1f1f1f; \">Tests and Treatment<\/h2>\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-toggle-wrap right\" style=\"color: #e32f68;\"><span class=\"wp-block-ub-content-toggle-accordion-state-indicator wp-block-ub-chevron-down\"><\/span><\/div>\n\t\t<\/div>\n\t\t\t<div role=\"region\" aria-expanded=\"false\" class=\"wp-block-ub-content-toggle-accordion-content-wrap ub-hide\" id=\"ub-content-toggle-panel-2-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\">\n\n<h2 class=\"wp-block-heading\">Tests<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">If a person experiences <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431054\/\">three or more episodes<\/a> of diarrhea within 24 hours, especially if they&#8217;ve recently been in the hospital or have used antibiotics, <em>C. difficile <\/em>should be considered. However, diagnosing a <em>C. difficile <\/em>infection isn&#8217;t always straightforward, and no single test gives a full clinical picture. For this reason, doctors typically use a two-step approach to confirm the diagnosis.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">How is <em>C. difficile <\/em>diagnosed?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Here are some of the <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431054\/\">most common tests<\/a> used to diagnose a <em>C. difficile <\/em>infection:<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Glutamate dehydrogenase (GDH) test<strong><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">This test detects a protein called glutamate dehydrogenase, which is produced by all <em>C. difficile <\/em>bacteria. It helps detect whether <em>C. difficile <\/em>is present in the stool. However, it doesn&#8217;t tell us if the bacteria are producing the toxins that cause symptoms.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Nucleic acid amplification tests (NAATs)<strong><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">NAATs (like PCR tests) look for the genes that allow <em>C. difficile <\/em>bacteria to produce toxins. While they&#8217;re very sensitive and accurate in detecting the bacteria, they do not confirm whether the presence of the genes leads to toxin production. If either the GDH or NAAT test is negative, it usually means <em>that C. difficile<\/em> isn&#8217;t the cause of the symptoms, and other causes should be investigated.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Toxin enzyme immunoassays (EIAs)<strong><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">This test detects toxins A and B, which are the substances produced by <em>C. difficile <\/em>that cause symptoms. This test confirms whether the <em>C. difficile <\/em>in your body is producing toxins. A positive GDH or NAAT result needs to be followed up with a confirmatory test, such as an EIA, to verify an active infection.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Toxigenic culture and cell culture tests<strong><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">These tests grow <em>C. difficile<\/em> bacteria in a laboratory from a stool sample and assess whether they can produce toxins. While it&#8217;s a very accurate way to identify the presence of <em>C. difficile <\/em>(and whether it&#8217;s producing toxins), it takes several days to get results and isn&#8217;t used in most urgent cases.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Imaging and endoscopy<strong><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">If doctors suspect the infection is severe (such as causing colitis or toxic megacolon), they may order abdominal X-rays or CT scans to assess for swelling or intestinal damage. They may also use lower GI endoscopy, such as a colonoscopy, to see the inside of your colon directly.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Overall, most experts recommend using two types of tests to assess for a <em>C. difficile <\/em>infection: one to test for the presence of the bacteria (such as a GDH or NAAT test), and another to confirm whether it&#8217;s producing harmful toxins (such as an EIA). This approach provides the most accurate diagnosis and can help guide proper treatment.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Treatments<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">How is <em>C. difficile <\/em>treated?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The main treatment for <em>C. difficile <\/em>infection is antibiotics. However, in the case of recurrent C. diff, fecal microbiota transplant (FMT) may be used. If a person tests positive for <em>C.<\/em> <em>difficile<\/em> but doesn&#8217;t have any symptoms, they don&#8217;t require treatment.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Antibiotic therapy<strong><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Two main antibiotics are now considered <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431054\/\">first-line treatments<\/a> for <em>C. difficile <\/em>infection. <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4692299\/\">Fidaxomicin<\/a> is the first choice, but <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC5114503\/\">vancomycin<\/a> is a suitable alternative if fidaxomicin is unavailable. While metronidazole was previously used to treat <em>C. difficile<\/em>, it&#8217;s associated with an increasing failure rate (i.e., it doesn&#8217;t effectively treat the infection), so it&#8217;s now only recommended if the other antibiotics aren&#8217;t an option.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Microbiome restoration therapy<strong><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Restoring the gut microbiota is essential for preventing recurrent <em>C. difficile <\/em>infections. These therapies aim to restore the gut microbiota to its original state, ensuring that there are sufficient &#8220;good&#8221; bacteria to outcompete &#8220;bad&#8221; bacteria, such as <em>C. difficile. <\/em>There are two main ways of restoring the gut microbiota:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fecal microbiota transplant (FMT): <\/strong><a href=\"https:\/\/myhealth.alberta.ca\/Health\/Pages\/Fecal-transplant-for-recurrent-clostridioides-difficile-(C.%20diff.)-infection.aspx?hwid=3Buzx84EDVw\">FMT<\/a> is a treatment in which healthy bacteria from a donor&#8217;s stool are transferred to the gut of a person with <em>C. difficile. <\/em>The goal is to restore a healthy balance of bacteria in the gut, thereby crowding out harmful bacteria like <em>C. difficile<\/em>. It&#8217;s usually done using an enema (but sometimes also given in a capsule or colonoscopy), which inserts the healthy bacteria directly through the anal canal and into the rectum. While FMT has been studied in clinical trials (particularly in people who also have underlying <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37098448\/\">inflammatory bowel disease<\/a>), Health Canada considers it to be an investigational drug (meaning that it&#8217;s still being studied and hasn&#8217;t yet been approved by health authorities for general use). However, there is an <a href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-health-products\/biologics-radiopharmaceuticals-genetic-therapies\/applications-submissions\/guidance-documents\/regulation-fecal-microbiota-therapy-treatment-difficile-infections.html\">interim policy<\/a> that allows for the use of FMT patients with recurrent C. diff who have not responded to antibiotic therapy.<\/li>\n\n\n\n<li><strong>Fecal microbiota, live <\/strong><strong>(<\/strong><strong><sup>Pr<\/sup><\/strong><strong>Rebyota\u00ae): <\/strong><a href=\"https:\/\/pdf.hres.ca\/dpd_pm\/00078790.PDF\">Rebyota<\/a> was approved by Health Canada in March 2025 for the prevention of recurrence of C. diff in adults following antibiotic treatment for recurrent <em>C. difficile <\/em>infection. It contains live, healthy bacteria from human stool and is administered as a single-dose enema to help restore gut microbiota balance and prevent <em>C. difficile<\/em> from recurring.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">A person is considered recovered from their <em>C. difficile <\/em>infection if their stools return to normal for at least 48 hours after finishing treatment. If symptoms come back within 8 weeks, it&#8217;s considered a recurrence. \u00a0<\/p>\n\n<\/div>\n\t\t<\/div>\n\n<div class=\"wp-block-ub-content-toggle-accordion\" style=\"border-color: #ffffff; \" id=\"ub-content-toggle-panel-block-\">\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-title-wrap\" style=\"background-color: #ffffff;\" aria-controls=\"ub-content-toggle-panel-3-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" tabindex=\"0\">\n\t\t\t<h2 class=\"wp-block-ub-content-toggle-accordion-title ub-content-toggle-title-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" style=\"color: #1f1f1f; \">Statistics<\/h2>\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-toggle-wrap right\" style=\"color: #e32f68;\"><span class=\"wp-block-ub-content-toggle-accordion-state-indicator wp-block-ub-chevron-down\"><\/span><\/div>\n\t\t<\/div>\n\t\t\t<div role=\"region\" aria-expanded=\"false\" class=\"wp-block-ub-content-toggle-accordion-content-wrap ub-hide\" id=\"ub-content-toggle-panel-3-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\">\n\n<ul class=\"wp-block-list\">\n<li><em>C. difficile <\/em>is ubiquitous (meaning that it&#8217;s found everywhere) and is found in the large intestines of <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15997485\/\">3% to 5%<\/a> of healthy people without causing symptoms.<\/li>\n\n\n\n<li><em>C. difficile <\/em>is the <a href=\"https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/fact-sheet-clostridium-difficile-difficile.html\">leading cause<\/a> of infectious diarrhea in hospitals and long-term care homes in Canada.\u00a0<\/li>\n\n\n\n<li><em>C. difficile <\/em>is responsible for approximately <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/37508237\/\">15% to 20%<\/a> of cases of antibiotic-associated diarrhea.<\/li>\n\n\n\n<li>There were approximately <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4503917\/\">37,932<\/a> <em>C. difficile <\/em>infections in Canada in 2012. Of these, 20,002 were in hospitals, 16,326 were in the community, and 1,604 were in long-term care facilities. Quebec had the most infections (16,562), followed by Ontario (9,962), British Columbia (5,168), and Alberta (3,659).<\/li>\n\n\n\n<li>It&#8217;s estimated that the <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC4503917\/\">economic burden<\/a> of <em>C. difficile <\/em>infections in Canada in 2012 surpassed CAD $280 million. Extended hospital stays and rehospitalizations made up 92% of this figure.<\/li>\n\n\n\n<li>There&#8217;s an estimated <a href=\"https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-clostridium-difficile-associated-diarrhea-can-be-associated-stomach\">1.4 to 2.75-fold<\/a> increased risk of <em>C. difficile <\/em>infections after using proton pump inhibitors (PPIs).<\/li>\n\n\n\n<li>The <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29941432\/\">NAP1 strain<\/a> of <em>C. difficile <\/em>is associated with significantly higher mortality rates compared with non-NAP1 strains.<\/li>\n\n\n\n<li>The rate of healthcare-associated <em>C. difficile <\/em>infection in Canada decreased from <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC6019340\/\">5.9 to 4.3<\/a> per 10,000 patient days between 2009 and 2015.<\/li>\n<\/ul>\n\n<\/div>\n\t\t<\/div>\n\n<div class=\"wp-block-ub-content-toggle-accordion\" style=\"border-color: #ffffff; \" id=\"ub-content-toggle-panel-block-\">\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-title-wrap\" style=\"background-color: #ffffff;\" aria-controls=\"ub-content-toggle-panel-4-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" tabindex=\"0\">\n\t\t\t<h2 class=\"wp-block-ub-content-toggle-accordion-title ub-content-toggle-title-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\" style=\"color: #1f1f1f; \">Frequently Asked Questions<\/h2>\n\t\t\t<div class=\"wp-block-ub-content-toggle-accordion-toggle-wrap right\" style=\"color: #e32f68;\"><span class=\"wp-block-ub-content-toggle-accordion-state-indicator wp-block-ub-chevron-down\"><\/span><\/div>\n\t\t<\/div>\n\t\t\t<div role=\"region\" aria-expanded=\"false\" class=\"wp-block-ub-content-toggle-accordion-content-wrap ub-hide\" id=\"ub-content-toggle-panel-4-8cbfb89c-aec9-4593-be35-02b1e0bf28a7\">\n\n<h3 class=\"wp-block-heading\">Is <em>C. difficile <\/em>contagious?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><em>C. difficile <\/em>is spread through the <a href=\"https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/fact-sheet-clostridium-difficile-difficile.html\">fecal-oral route<\/a>. If a person touches a surface contaminated with feces that contain <em>C. difficile <\/em>bacteria or spores and then touches their mouth, they may contract a <em>C. difficile <\/em>infection.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Can <em>C. difficile <\/em>come back after treatment?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Yes, in approximately <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/c-difficile\/diagnosis-treatment\/drc-20351697\">25% of cases<\/a>, <em>C. difficile<\/em> recurs after treatment. This is known as a recurrent <em>C. difficile <\/em>infection (recurrent C. diff). After a person has had three or more CDIs, the risk of having the infection recur again increases to over 50%.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Why do antibiotics increase the risk of <em>C. difficile <\/em>infection?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Using <a href=\"https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/fact-sheet-clostridium-difficile-difficile.html\">antibiotics<\/a> (especially broad-spectrum antibiotics that target a wide range of bacteria) in high doses or over a long time period increases the chance of developing a <em>C. difficile <\/em>infection because antibiotics can cause dysbiosis (an imbalance of bacteria in the gut). When our gut has fewer &#8220;good&#8221; bacteria, <em>C. difficile <\/em>bacteria are able to proliferate and produce toxins that can damage the gut, causing diarrhea.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">What makes <em>C. difficile <\/em>infections so difficult to treat?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><em>C. difficile <\/em>is a <a href=\"https:\/\/pmc.ncbi.nlm.nih.gov\/articles\/PMC7452994\/\">spore-forming bacterium<\/a>. Spores are tough, protective &#8220;shells&#8221; that the bacteria create to survive harsh conditions, such as stomach acid or antibiotics. They can remain dormant for a long time, becoming active only when the conditions are suitable for growth. <em>C. difficile<\/em> spores are resistant to stomach acid and can pass through to the large intestine. Once they reach the large intestine, they either remain as spores or grow into vegetative forms (bacteria). While a healthy gut microbiota usually prevents <em>C. difficile <\/em>from proliferating, disruptions to the normal gut microbiota (such as following broad-spectrum antibiotic therapy) may lead to overgrowth of <em>C. difficile.<\/em><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Can probiotics help prevent <em>C. difficile <\/em>infections?<strong><\/strong><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">While research into the role of probiotics in preventing <em>C. difficile <\/em>infections is emerging, the Association of Medical Microbiology and Infectious Disease (AAMI) Canada <a href=\"https:\/\/utppublishing.com\/doi\/10.3138\/jammi.2018.02.13\">guidelines<\/a> state that &#8220;at this time, there is insufficient evidence to support the use of probiotics for primary prevention of <em>C. difficile <\/em>infection.&#8221;<\/p>\n\n<\/div>\n\t\t<\/div>\n<\/div>\n\n<div class=\"gradient-divider\"><\/div><div class=\"sponsor-block wp-block-cdhf2022-cdhf-sponsor\"><p>This content was made possible due to an unrestricted educational grant from Ferring.&nbsp;<\/p><div class=\"sponsor-details\"><div class=\"photo\"><a target=\"_blank\" rel=\"noopener noreferrer\" href=\"https:\/\/www.ferring.ca\/en\/home\/\"><img src=\"data:image\/gif;base64,R0lGODlhAQABAIAAAAAAAP\/\/\/yH5BAEAAAAALAAAAAABAAEAAAIBRAA7\" data-src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2025\/07\/FERRINGLOGO-300x139.webp\" width=\"300\" height=\"139\" class=\"attachment-medium size-medium lazyload\" alt=\"Ferring\" loading=\"lazy\" decoding=\"async\"><noscript><img width=\"300\" height=\"139\" src=\"https:\/\/cdhf.ca\/wp-content\/uploads\/2025\/07\/FERRINGLOGO-300x139.webp\" class=\"attachment-medium size-medium\" alt=\"Ferring\" loading=\"lazy\" decoding=\"async\"><\/noscript><\/a><\/div><\/div><\/div>\n\n\n<h2 class=\"wp-block-heading has-small-font-size\">References<\/h2>\n\n\n\n<ol start=\"1\" class=\"wp-block-list\">\n<li class=\"has-small-font-size\">Mada P. K., Alam M. U. (2024, April 10). Clostridioides difficile infection. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431054\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK431054\/<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Government of Canada (2014, May 2). <em>Fact Sheet &#8211; Clostridium difficile (C. Difficile)<\/em>. Retrieved July 1, 2025, from <a href=\"https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/fact-sheet-clostridium-difficile-difficile.html\">https:\/\/www.canada.ca\/en\/public-health\/services\/infectious-diseases\/fact-sheet-clostridium-difficile-difficile.html<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Mayo Clinic (2023, September 1). <em>C. Difficile infection<\/em>. Retrieved July 1, 2025, from <a href=\"https:\/\/www.mayoclinic.org\/diseases-conditions\/c-difficile\/diagnosis-treatment\/drc-20351697\">https:\/\/www.mayoclinic.org\/diseases-conditions\/c-difficile\/diagnosis-treatment\/drc-20351697<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Zhanel, G. G., Walkty, A. J., &amp; Karlowsky, J. A. (2015). Fidaxomicin: A novel agent for the treatment of Clostridium difficile infection. <em>The Canadian Journal of Infectious Diseases &amp; Medical Microbiology<\/em>, <em>26<\/em>(6), 305. <a href=\"https:\/\/doi.org\/10.1155\/2015\/934594\">https:\/\/doi.org\/10.1155\/2015\/934594<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Zhanel, G. G., Walkty, A. J., &amp; Karlowsky, J. A. (2015). Fidaxomicin: A novel agent for the treatment of Clostridium difficile infection. <em>The Canadian Journal of Infectious Diseases &amp; Medical Microbiology<\/em>, <em>26<\/em>(6), 305. <a href=\"https:\/\/doi.org\/10.1155\/2015\/934594\">https:\/\/doi.org\/10.1155\/2015\/934594<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Government of Alberta (2025, January 28). <em>Fecal transplant for recurrent Clostridioides difficile (C. Diff.) infection<\/em>. MyHealth.Alberta.ca. Retrieved July 1, 2025, from <a href=\"https:\/\/myhealth.alberta.ca\/Health\/Pages\/Fecal-transplant-for-recurrent-clostridioides-difficile-(C.%20diff.)-infection.aspx?hwid=3Buzx84EDVw\">https:\/\/myhealth.alberta.ca\/Health\/Pages\/Fecal-transplant-for-recurrent-clostridioides-difficile-(C.%20diff.)-infection.aspx?hwid=3Buzx84EDVw<\/a>&nbsp;<\/li>\n\n\n\n<li class=\"has-small-font-size\">Porcari, S., Baunwall, S. M. D., Occhionero, A. S., Ingrosso, M. R., Ford, A. C., Hvas, C. L., Gasbarrini, A., Cammarota, G., &amp; Ianiro, G. (2023). Fecal microbiota transplantation for recurrent C. difficile infection in patients with inflammatory bowel disease: A systematic review and meta-analysis. <em>Journal of Autoimmunity<\/em>, <em>141<\/em>, 103036. <a href=\"https:\/\/doi.org\/10.1016\/j.jaut.2023.103036\">https:\/\/doi.org\/10.1016\/j.jaut.2023.103036<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Government of Canada (2022, September 28). <em>Guidance document: Fecal microbiota therapy used in the treatment of Clostridioides difficile infection not responsive to conventional therapies<\/em>. Retrieved July 1, 2025, from <a href=\"https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-health-products\/biologics-radiopharmaceuticals-genetic-therapies\/applications-submissions\/guidance-documents\/regulation-fecal-microbiota-therapy-treatment-difficile-infections.html\">https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-health-products\/biologics-radiopharmaceuticals-genetic-therapies\/applications-submissions\/guidance-documents\/regulation-fecal-microbiota-therapy-treatment-difficile-infections.html<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">(2025, March 5). <em>Rebyota Product Monograph<\/em>. Ferring Inc. Retrieved July 1, 2025, from <a href=\"https:\/\/pdf.hres.ca\/dpd_pm\/00078790.PDF\">https:\/\/pdf.hres.ca\/dpd_pm\/00078790.PDF<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Bouza, E., Mu\u00f1oz, P., &amp; Alonso, R. (2005). Clinical manifestations, treatment and control of infections caused by Clostridium difficile. <em>Clinical Microbiology and Infection: the official publication of the European Society of Clinical Microbiology and Infectious Diseases<\/em>, <em>11 Suppl 4<\/em>, 57\u201364. <a href=\"https:\/\/doi.org\/10.1111\/j.1469-0691.2005.01165.x\">https:\/\/doi.org\/10.1111\/j.1469-0691.2005.01165.x<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Liu, C., Monaghan, T., Yadegar, A., Louie, T., &amp; Kao, D. (2023). Insights into the Evolving Epidemiology of <em>Clostridioides difficile<\/em> Infection and Treatment: A Global Perspective. <em>Antibiotics (Basel, Switzerland)<\/em>, <em>12<\/em>(7), 1141. <a href=\"https:\/\/doi.org\/10.3390\/antibiotics12071141\">https:\/\/doi.org\/10.3390\/antibiotics12071141<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Levy, A. R., Szabo, S. M., Lozano-Ortega, G., Lloyd-Smith, E., Leung, V., Lawrence, R., &amp; Romney, M. G. (2015). Incidence and Costs of Clostridium difficile Infections in Canada. <em>Open Forum Infectious Diseases<\/em>, <em>2<\/em>(3), ofv076. <a href=\"https:\/\/doi.org\/10.1093\/ofid\/ofv076\">https:\/\/doi.org\/10.1093\/ofid\/ofv076<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">U.S. Food &amp; Drug Administration (2017, September 5). <em>FDA Drug Safety Communication: Clostridium difficile associated diarrhea can be associated with stomach acid drugs known as proton pump inhibitors (PPIs)<\/em>. Retrieved July 1, 2025, from <a href=\"https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-clostridium-difficile-associated-diarrhea-can-be-associated-stomach\">https:\/\/www.fda.gov\/drugs\/drug-safety-and-availability\/fda-drug-safety-communication-clostridium-difficile-associated-diarrhea-can-be-associated-stomach<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Katz, K. C., Golding, G. R., Choi, K. B., Pelude, L., Amaratunga, K. R., Taljaard, M., Alexandre, S., Collet, J. C., Davis, I., Du, T., Evans, G. A., Frenette, C., Gravel, D., Hota, S., Kibsey, P., Langley, J. M., Lee, B. E., Lemieux, C., Longtin, Y., Mertz, D., \u2026 Canadian Nosocomial Infection Surveillance Program (2018). The evolving epidemiology of <em>Clostridium difficile<\/em> infection in Canadian hospitals during a postepidemic period (2009-2015). <em>CMAJ : Canadian Medical Association Journal = Journal de l&#8217;Association Medicale Canadienne<\/em>, <em>190<\/em>(25), E758\u2013E765. <a href=\"https:\/\/doi.org\/10.1503\/cmaj.180013\">https:\/\/doi.org\/10.1503\/cmaj.180013<\/a><\/li>\n\n\n\n<li class=\"has-small-font-size\">Loo, V. G., Davis, I., Embil, J., Evans, G. A., Hota, S., Lee, C., Lee, T. C., Longtin, Y., Louie, T., Moayyedi, P., Poutanen, S., Simor, A. E., Steiner, T., Thampi, N., &amp; Valiquette, L. (2018). Association of Medical Microbiology and Infectious Disease Canada treatment practice guidelines for Clostridium difficile infection. <em>Journal of the Association of Medical Microbiology and Infectious Disease Canada<\/em>, <em>3<\/em>(2). <a href=\"https:\/\/doi.org\/10.3138\/jammi.2018.02.13\">https:\/\/doi.org\/10.3138\/jammi.2018.02.13<\/a>&nbsp;<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>C. difficile is a common infection Learn what it is, and how to recognize symptoms early. References<\/p>\n","protected":false},"author":2,"featured_media":60317,"template":"","categories":[],"tags":[197],"class_list":["post-60315","digestive-condition","type-digestive-condition","status-publish","has-post-thumbnail","hentry","tag-c-diff-2"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.1.1 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Clostridiodes Difficile (C. difficile) Infection - Canadian Digestive Health Foundation<\/title>\n<meta name=\"description\" content=\"C. difficile is a common and potentially serious infection- learn how to prevent it, recognize symptoms early, and protect your gut health.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cdhf.ca\/en\/digestive-conditions\/clostridiodes-difficile-c-difficile-infection\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Clostridiodes Difficile (C. difficile) Infection - 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