Clostridioides difficile infections (C. diff, CDI)

About This Disease

Clostridioides difficile is a bacterium that causes diarrhea and inflammation of colon, known as colitis. People who have other illnesses or conditions requiring prolonged use of antibiotics, and the elderly, are at greater risk of acquiring this disease. C. difficile can be found in feces of those who are sick with C. difficile infections (CDI). People can become infected if they touch items or surfaces that are contaminated with feces and then touch their mouth or mucous membranes. Healthcare workers can spread the bacteria to patients or contaminate surfaces through hand contact.

Clostridioides difficile is also called c. difficile , c. diff, CDI (Clostridioides difficile infection) or CDAD (Clostridioides difficile-associated disease).  It used to be called Clostridium difficile.

Signs and Symptoms

The symptoms of CDI can include:

  • watery diarrhea (at least three bowel movements per day for two or more days
  • fever
  • loss of appetite
  • nausea
  • abdominal pain/tenderness

CDI can sometimes lead to serious complications such as colitis and sepsis.


C. difficile is shed in feces or stool. Any surface, device, or material (e.g., toilets, bathing tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the C. difficile spores. C. difficile spores are transferred to patients mainly via the hands of healthcare personnel and visitors who have touched a contaminated surface or item. C. difficile can live for long periods on surfaces.


If you have symptoms of CDI, your healthcare provider may conduct a stool test to determine the presence of C. difficile.


The infection can usually be treated with an appropriate course (about 10 days) of antibiotics, including metronidazole, vancomycin (administered orally), or recently approved fidaxomicin.

Risk in Hawaii

Healthy people usually do not get CDI, however the following will increase the risk of developing CDI:

  • taking antibiotics
  • proton pump inhibitors (medications to help acid reflux or gastroesophageal reflux disease)
  • recent stay at a hospital or nursing home
  • a serious underlying illness or weakened immune system (such as with HIV/AIDS, cancer, or organ transplant patients taking immunosuppressive medications)
  • advanced age (65 or older)
  • previous infection with C.diff or known exposure to the germs

The Department of Health prepares an annual report on specific healthcare-associated infections from select hospitals, which is available here. In 2018, 174 hospital-onset CDI cases were reported.


The best way to prevent CDI include:

  • Take antibiotics only as prescribed by their doctor and complete the prescribed course of treatment.
  • Tell your doctor if you have been on antibiotics and get diarrhea within a few months.
  • Wash your hands with soap and water (not alcohol based hand rub) before eating and after using the bathroom.
  • Try to use a separate bathroom, or be sure the bathroom is cleaned well if someone with diarrhea has used it; clean first then disinfect with mixing 1 part bleach to 9 parts water.
  • Additional guidance regarding cleaning high touch surfaces and handling laundry can be found at the CDC website.

Information for Clinicians

Clinicians play a critical role in slowing the spread of CDI. Poor prescribing practices put patients at risk for CDI. More than half of all hospitalized patients will get an antibiotic at some point during their hospital stay, but studies have shown that 30-50% of antibiotics prescribed in hospitals are unnecessary or incorrect. Additionally, rapidly identifying patients with CDI and using appropriate infection control recommendations can of preventing CDI transmission.

SHEA’s Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update

Core Elements of Hospital Antibiotic Stewardship Programs


Last reviewed August 2022