is a bacterium (germ) that can cause a serious and potentially life-threatening infection associated with symptoms ranging from diarrhea to severe intestinal infections.1,2
The spores are found throughout the environment in soil, household objects such as bathroom ﬁxtures, human and animal feces, and in contaminated food products.1,3,4,5 They have the ability to exist and spread in an inactive state known as spores, which are highly resilient and easily transmissible.6,7
C. difﬁcile spores are resistant to heat and other common cleaning agents like detergents and alcohol-based hand sanitizers,7,8 and the bacteria can persist on hard surfaces for up to ﬁve months.9,10
CDI disproportionately affects older adults and represents an important health burden in adults 65 years of age and older.11
Nearly two thirds of cases occur in individuals over 65 years of age, and one out of 11 US adults aged 65 and older with healthcare-associated CDI will die within one month of diagnosis.12,15
Common symptoms of CDI include watery diarrhea more than three times a day;1,13 abdominal tenderness or pain; fever; nausea; and loss of appetite.1,14
Severe symptoms may include swelling or inﬂammation of the large intestine, toxic megacolon (a rare yet life-threatening complication of severe colon disease or infection), and in some cases may even result in death.1
An animated video explaining what C. difﬁcile and CDI are, as well as the risk factors and burden of the disease.
1 . Mayo Clinic. C. difﬁcile Infection. https://www.mayoclinic.org/diseases-conditions/c-difﬁcile/symptoms-causes/syc-20351691. Accessed on May 2020.
2. Centers for Disease Control and Prevention (CDC). Antibiotic Resistance Threats in the United States, 2019. Atlanta, GA: U.S. Department of Health and Human Services, CDC; 2019.
3. Curry SR. Clostridium difﬁcile. Clin Lab Med. 2010; 30(1), 329-42. doi: 10.1016/j.cll.2010.04.001.
4 . DePestel DD, Aronoff DM. Epidemiology of Clostridium difﬁcile Infection. J Pharm Pract. 2013; 26(5):464-475. Doi: 10.1177/0897190013499521. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4128635/pdf/nihms610787.pdf.
5. Janezic S, Potocnik M, Zidaric C, et al. High divergent Clostridium difﬁcile strains isolated from the environment. Plos One. Nov. 23, 2016. https://doi. org/10.1371/journal.pone.0167101.
6. Cohen SH et al. Infect Control Hosp Epidemiol. 2010;31:431-455.
7. Cole SA, Stahl A. Persistent and recurrent Clostridium difﬁcile colitis. Clin Colon Rectal Surg. 2015;28(2);65-69. doi:10.1055/s-0035-1547333. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442717.
8. Mullish BH, Williams HR. Clostridium difﬁcile infection and antibiotic-associated diarrhoea. Clin Med (Lond). 2018;18(3):237–241. doi:10.7861/ clinmedicine.18-3-237.
9 . Fawley WN, Underwood S, Freeman J, et al. Efﬁcacy of hospital cleaning agents and germicides against epidemic Clostridium difﬁcile strains. Infect Control Hosp Epidemiol. 2007;28:920-925.
10. Gerding DN, Muto CA, Owens RC Jr. Treatment of Clostridium difﬁcile infection. Clin Infect Dis. 2008 Jan 15;46 Suppl 1:S32-42. doi: 10.1086/521860. https://www.ncbi.nlm.nih.gov/pubmed/18177219.
11. Pechal A, Lin K, Allen S, Reveles K. National age group trends in Clostridium difﬁcile infection incidence and health outcomes in United States Community Hospitals. BMC Infectious Diseases. 2016;16(1),682.doi:10.1186/s12879-016-2027-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114740.
12. Centers for Disease Control and Prevention (CDC). C. difﬁcile Factsheet. https://www.cdc.gov/cdiff/pdf/Cdiff-Factsheet-508.pdf. Accessed May 2020.
13. Centers for Disease Control and Prevention (CDC). What is C. diff? https://www.cdc.gov/cdiff/what-is.html. Accessed May 2020.
14. Centers for Disease Control and Prevention (CDC). FAQs for Clinicians about C. diff. https://www.cdc.gov/cdiff/clinicians/faq.html#anchor_1529601716735. Accessed May 2020.
15. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372:825- 834. DOI: 10.1056/NEJMoa1408913.