Clostridioides difficile


What is Clostridioides difficile?

Clostridioides difficile (“C. difficile” or “C. diff”) is a type of spore-forming bacteria that produces two types of toxins.

What are the symptoms?

The main clinical symptoms of C. difficile infection (CDI) are watery diarrhea, fever, nausea, abdominal pain/tenderness, and loss of appetite. More serious conditions can also result such as pseudomembranous colitis (inflammation of the colon), perforations of the colon, and sepsis.

What is C. diff colonization?

It is possible to carry C. diff bacteria in your body but not show any symptoms; this is called colonization. After treatment, repeat testing is not recommended if the patient’s symptoms have resolved, since many patients remain colonized with the bacteria.

Who is at risk?

Some patients/residents may be at higher risk for developing C. diff due to prolonged use of antibiotics, underlying gastrointestinal issues or prior gastrointestinal surgery, history of frequent hospitalizations, immunocompromised status, advanced age, or other underlying chronic health conditions. It is important that both the patient and the healthcare providers take the appropriate steps to help prevent an infection.

Infection Prevention

To prevent CDI, doctors, nurses, and other healthcare providers should follow CDC infection prevention guidelines including:

Use antibiotics judiciously.

Implement contact precautions for patients/residents with known or suspected CDI:

  • Place patients/residents with CDI in private rooms.  If private rooms are not available, patients/residents can be placed in rooms (cohorted) with other persons with CDI.
  • Use gloves when entering the room of a patient/resident with CDI and during patient/resident care.
  • Perform hand hygiene after removing gloves.
    • Because alcohol does not kill C. difficile spores, use of soap and water is more efficacious than alcohol-based hand rubs. However, early experimental data suggest that, even using soap and water, the removal of C. difficile spores is more challenging than the removal or inactivation of other common pathogens.
    • Preventing contamination of the hands via glove use remains the cornerstone for preventing C. difficile transmission via the hands of healthcare workers.
    • If your institution experiences an outbreak, consider using only soap and water for hand hygiene when caring for patients/residents with CDI.
  • Use gowns when entering the room of a patient/resident with CDI and during patient/resident care.
  • Use dedicated medical equipment or perform cleaning and disinfection of any shared medical equipment.
  • Continue these precautions until diarrhea ceases.
    • Because patients/residents with CDI continue to shed the bacteria for a number of days after diarrhea stops, some facilities routinely continue isolation for either several days beyond symptom resolution or until discharge, depending upon the type of setting and average length of stay.

Implement an environmental cleaning and disinfection strategy:

  • Ensure adequate cleaning and disinfection of environmental surfaces and reusable devices, especially items likely to be contaminated with feces and surfaces that are touched frequently.
  • Consider using an Environmental Protection Agency (EPA)-registered disinfectant with a sporicidal claim for environmental surface disinfection after cleaning in accordance with label instructions. Generic sources of hypochlorite (e.g., household chlorine bleach) also may be appropriately diluted and used.
    • Note: Standard EPA-registered hospital disinfectants are not effective against Clostridioides difficile spores.
    • Hypochlorite-based disinfectants may be most effective in preventing C. difficile transmission in units with high endemic rates of C. difficile infection.

Reporting Requirements


Impact in the United States


  • In a recent national prevalence survey, Clostridioides difficile was the most commonly reported pathogen, causing 12% of HAIs, and an estimated 80,400 hospital-onset infections (citation).
  • According to the latest CDC National and State HAI Progress Report, in 2014, acute care hospitals experienced an 8% reduction in hospital-onset C. difficile infections compared to 2011.
    • Virginia hospitals experienced a 2% reduction in hospital-onset C. difficile infections between 2011 and 2013.
  • C. difficile accounts for 15-25% of all episodes of antibiotic-associated diarrhea.
  • In Virginia, hospitalizations for C. difficile increased from 9 per 100,000 people in 2000 to 29 per 100,000 people in 2010. (citation)  In 2010 in Virginia:
    • The rate of hospitalization with C. difficile was more than twice as high for people 85 years or older than for people 65 to 84 years of age.
    • Compared to men, C. difficile hospitalization rates were 30% higher for women.
  • In 2009, patients diagnosed with C. difficile in Virginia hospitals stayed an average of 13.2 days, almost three times as long as the average stay of all other patients (4.6 days). (citation)


  • CDI has been associated with an attributable mortality rate of 6.9% at 30 days after diagnosis and 16.7% at 1 year. (citation)


  • Nationally, the estimated cost per infection ranges from $6,000 - $9,000 and the estimated total cost per year ranges from $1 billion - $1.6 billion. (citation)
  • In 2009 in Virginia, the total hospital cost for patients with C. difficile was over $157 million. The average hospital cost for patients with C. difficile was nearly three times higher than patients without C. difficile ($23,190 vs. $8,860). (citation)


For more patient resources, please see the Infection Prevention page or go to the CDC C. difficile website.

Opens pdf to download

Opens document to download

Opens in a new window

External link will open in new window.  Click link to exit Virginia Department of Health Website.