C. diff
A dangerous opportunist. Clostridioides difficile takes over when antibiotics wipe out protective gut bacteria. It produces toxins that damage the intestinal lining, causing severe diarrhea and potentially life-threatening colitis. Recurrence is common—restoring the microbiome is critical.
Risk Factors
Recent Antibiotics
Biggest risk. Clindamycin, fluoroquinolones, cephalosporins. Destroys protection.
Hospitalization
C. diff spores in healthcare settings. Environmental contamination.
Age Over 65
Higher risk and mortality. Weaker immune response. More antibiotic exposure.
PPI Use
Acid suppression increases risk. Stomach acid kills spores normally.
Immune Suppression
Chemotherapy, steroids, HIV. Reduced ability to fight infection.
Previous C. diff
Each episode increases recurrence risk. Spores persist. Microbiome weakened.
Symptoms & Diagnosis
Watery Diarrhea
10+ times daily. Distinctive foul smell. May have blood or mucus.
Abdominal Pain
Cramping, tenderness. May indicate severe colitis. Watch for rebound.
Fever
Low to moderate fever common. High fever indicates severe infection.
Testing
PCR for toxin genes. GDH screen. Toxin A/B testing. Stool sample.
Treatment & Prevention
Stop Causative Antibiotic
If possible, discontinue the antibiotic that triggered infection.
Vancomycin/Fidaxomicin
Oral antibiotics specifically for C. diff. Fidaxomicin has lower recurrence.
FMT
Fecal microbiota transplant. 90% effective for recurrent cases. Restores microbiome.
S. boulardii
Probiotic yeast. Reduces recurrence. Take during and after antibiotics.
Microbiome Restoration
Diverse probiotics after treatment. Prebiotic fiber. Fermented foods slowly.
Antibiotic Stewardship
Prevention: avoid unnecessary antibiotics. Shortest effective course.