Fact Sheet - Clostridium difficile (C. difficile)

What is Clostridium difficile (C. difficile)?

Clostridium difficile (C. difficile) is a bacterium that causes mild to severe diarrhea and intestinal conditions like pseudomembranous colitis (inflammation of the colon). C. difficile is the most frequent cause of infectious diarrhea in hospitals and long-term care facilities in Canada, as well as in other industrialized countries.

Most cases of C. difficile occur in patients who are taking certain antibiotics in high doses or over a prolonged period of time. Some antibiotics can destroy a person's normal bacteria found in the gut, causing C. difficile bacteria to grow. When this occurs, the C. difficile bacteria produce toxins, which can damage the bowel and cause diarrhea. However, some people can have C. difficile bacteria present in their bowel and not show symptoms.

There are many different strains of C. difficile and one strain, North American Pulsed Field type 1, known as NAP1, is likely to cause serious illness.

How do people get C. difficile?

C. difficile bacteria and their spores are found in feces. People can get infected if they touch surfaces contaminated with feces, and then touch their mouth. Healthcare workers can spread the bacteria to their patients if their hands are contaminated.

For healthy people, C. difficile does not pose a health risk. The elderly and those with other illnesses or who are taking antibiotics, are at a greater risk of infection.

How does using antibiotics contribute to the development of C. difficile?

Certain antibiotics used in high doses or over a prolonged period of time will increase the chance of developing a C. difficile infection. Antibiotics alter the normal levels of bacteria found in the gut. When there are fewer bacteria in our gut, C. difficile bacteria have the chance to thrive and produce toxins. These toxins can damage the bowel and cause diarrhea. The presence of C. difficile bacteria, together with a large number of patients receiving antibiotics in healthcare settings, can lead to frequent C. difficile outbreaks. In healthcare settings, C. difficile infections can be limited through careful use of antibiotics and strict adherence to infection prevention and control measures.

The Public Health Agency of Canada (PHAC) has developed infection prevention and control guidance on proper hand hygiene and antimicrobial resistance.

What are the symptoms of C. difficile?

Symptoms include watery diarrhea, fever, loss of appetite, nausea, and abdominal pain/tenderness.

What can be done to prevent the spread of C. difficile?

As with any infectious disease, frequent hand hygiene is the most effective way of preventing the transmission of healthcare associated infections. Hand washing with soap and water is important during C. difficile outbreaks and is one of the best defences against further spread of the bacteria.

If you do not have access to soap and water, frequent use of alcohol-based hand rubs is encouraged. Most healthcare facilities provide alcohol-based hand rubs at entrances. Be sure to use them, but be aware that they are less effective than washing with soap and water as they do not destroy C. difficile spores.

If you work in or visit a hospital or long-term healthcare facility, wash your hands often preferably with soap and water, especially after using the toilet. Gloves should be worn when caring for a patient with C. difficile infection or if in contact with his/her environment. Use a new pair of gloves when caring for each patient. Be sure to wash your hands with soap and water after removing your gloves.

When antibiotics are prescribed, follow your doctor, pharmacist, or healthcare provider's instructions and the directions on the label. Keep taking the antibiotics as prescribed to kill all of the C. difficile bacteria.

If you have concerns about C. difficile and medication you are currently using, talk to your doctor, pharmacist, or healthcare provider.

Is C. difficile fatal?

In some circumstances, C. difficile can be fatal. C. difficile can cause mild diarrhea, to life-threatening pseudomembranous colitis, bowel perforation, sepsis, and even death.

How is C. difficile treated?

For people with mild symptoms, no treatment may be required. For more severe cases, medication and sometimes surgery may be necessary. There are also new treatments, such as fecal transplantation, currently being studied for treating persistent C. difficile infection.

What puts a person at risk of getting C. difficile infection?

People in healthcare settings are most at risk of acquiring this type of infection because C. difficile is often a healthcare-associated infection. These types of infections can be transmitted within a hospital when infection prevention and control measures are not followed.

Those at higher risk include the elderly, people with severe underlying illness, and people taking certain antibiotics (especially over a prolonged period of time) or cancer chemotherapy. In addition, patients taking stomach ulcer drugs, known as proton pump inhibitors, are at increased risk for contracting C. difficile infection.

What is the Public Health Agency of Canada's role in preventing and monitoring C. difficile?

The Public Health Agency of Canada publishes infection prevention and control guidelines as a resource for healthcare and public health professionals in provinces and territories. In January 2013, the Agency released updated guidance for the treatment of C. difficile in long-term care facilities, as well as, in acute care settings. Additionally, the Agency has has provided technical support to provinces and territories to address outbreaks of C. difficile infections.

To better understand risk patterns and trends in Canada, C. difficile became a notifiable disease under national surveillance in 2009 through the Canadian Notifiable Disease Surveillance System. The Agency works closely with our provincial and territorial partners to monitor and control C. difficile infections across Canada.

The Agency leads the Canadian Nosocomial Infection Surveillance Program (CNISP). With the participation of over 50 hospitals, CNISP is a national sentinal surveillance system that monitors healthcare associated infections in hospitals across all 10 Canadian provinces. As part of this program, participating hospitals report all cases of C. difficile infections. As well, periodic surveys are conducted of all hospitals in Canada to get a better understanding of their infection prevention and control practices for C. difficile. All these results are used to inform and improve surveillance activities and infection prevention and control guidance related to C. difficile across the country.

Additionally, the Agency's National Microbiology Laboratory provides reference services to any hospital or provincial public health laboratory requiring assistances in identifying and typing isolates. They also provide assistance to veterinary laboratories to potentially assess zoonotic transmission of toxigenic C. difficile.