Clostridium difficile (C. diff) Infection
Authors: Ryan Brenneis, Sravya Kakumanu Reviewers: Yoyo Chan, Sean Doherty, Vina Fan, Ben Campbell, Dr. Steve Vaughan*, Dr. Sylvain Coderre* * MD at time of publication
Community exposure
Infected close contacts
Nosocomial exposure (most common)
Poor hand hygiene and sanitization of surfaces and medical equipment
Nosocomial risk factors
Any antibiotic use
(Especially clindamycin, fluoroquinolones, penicillins, cephalosporins)
↑ Antibiotic resistant strains
Presence of pre-disposing risk factors
(Note: do not need to be present for infection)
Recent GI surgery
Chemotherapy that has antimicrobial and immunosuppressive effects
Usage of medications that reduce stomach acid (↑ pH)
↑ C. diff spores on surfaces and personnel
Contact exposure
Environmental exposure
to C. diff carriers
Inoculation of GI tract
Disruption of normal gut microbiome allowing C. diff overgrowth
(>65 years old, cirrhosis, inflammatory bowel disease, enteral feeding, obesity)
via fecal-oral route
Clostridium difficile Infection of GI Tract
Spores unaffected by antibiotics germinate post-antibiotic treatment
Infection recurrence
Pseudomembranous colitis on endoscopy
(colonic ulcerations potentially seen with severe infection)
Hypotension Acute kidney injury
Release of C. diff toxin A and B inactivates Rho and Ras GTPases in colonic epithelial cells (colonocytes)
(Rho and Ras GTPases control cytoskeletal dynamics and gene expression)
Cytoskeletal disorganization and arrest of RNA synthesis causes necrosis of colonocytes and triggers host immune response
Neutrophil chemotaxis and activation
↑ Inflammation of colon
Disruption of tight junctions between colonocytes
Release of fluid into intestinal lumen and inability of colon to reabsorb it
Toxic megacolon
Bowel perforation
Bloody stool
(<10% of patients) Abdominal cramps Large bowel dilation from muscle paralysis Inflammation and destruction of underlying smooth muscle Breakdown of colonocyte cell membranes Inflammation of visceral peritoneum Volume depletion Watery diarrhea: ↑ frequency, small volume Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published March 30, 2019, updated May 16, 2022 on