Long-term problems after an infection with Clostridioides difficile (C. diff) can include lingering symptoms and a return of the infection (recurrence). However, other consequences go beyond physical health, such as mental health problems, financial burdens, and disruptions in working life.
Anyone can get sick from C. diff, an infectious bacterium that lives in the intestines. C. diff makes spores that are shed in feces and can live on surfaces for up to five months, even after cleaning with disinfectants.
Once on your hands, the bacterium enters your body through your mouth and travels through your digestive tract to your intestines (fecal–oral route). C. diff can cause severe and dangerous diarrhea. Standard antibiotic treatment clears most infections. However, sometimes additional treatments are needed.
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C. Diff Symptoms
The most common symptoms of a C. diff infection are:
- Diarrhea (often watery and with a strong odor)
- Abdominal pain and cramps
- Nausea/vomiting
- Fever
- Belly tenderness or bloating (if severe infection)
In the United States, there are nearly 500,000 C. diff infections (CDI) reported each year.
Risk Factors
The major risk factors for developing C. diff infection are:
- Taking antibiotics
- Having a weakened immune system (cancer treatment, human immunodeficiency virus, some medications)
- Being older (age above 65 years)
- Residing in a community-living environment, like nursing homes
- Having had a previous C. difficile infection
- Having inflammatory bowel disease (IBD)
- Having had surgery involving the intestines
Transmission
C. diff is easily spread from person to person. It can also be picked up by touching contaminated surfaces. It is a common hospital-acquired infection (HAI). Being in a healthcare facility like a hospital or nursing home raises your risk of a C. diff infection.
How Long It Take to Recover?
Typically, C. diff infections are treated for 10–14 days with an oral antibiotic. Once diarrhea resolves, it is usually safe to return to your normal activities as long as you are feeling well.
Most people recover from C. diff infection during the first course of treatment, while others may require additional medical interventions. Generally, the long-term effects of C. diff infection can be managed with support from your medical team.
Life After C. Diff
Most of the time, people will develop C. diff symptoms after taking antibiotics for a different infection. Antibiotics, which are medications to kill infectious bacteria, also sometimes kill the normal, healthy gut bacteria. The environment in the intestines gets out of balance and “bad” bacteria like C. diff are able to increase.
Your experience will be unique, but your medical team can help you to navigate through recovery and to deal with any long-term issues related to your illness.
Physical Issues
Even after recovery from CDI, some people continue to experience physical problems. Long-term problems after CDI include persistent symptoms, such as irritable bowel syndrome (IBS) symptoms, and poor sleep.
CDI can also result in significant health complications. People with recurrent infections are at higher risk of complications.
Common complications include:
- Dehydration
- Colitis (an inflammation of the colon)
The C. diff bacteria can produce toxins that irritate the digestive system and cause diarrhea. Some people have up to 15 episodes of diarrhea each day. The frequent watery diarrhea can lead to dehydration and even kidney damage.
Preventing dehydration and replacing lost electrolytes are important parts of CDI management. Some people find that altering their diet can help with some of the diarrhea symptoms of CDI.
The C. diff toxins can irritate the lower part of the intestines, causing colitis. The colon then swells and becomes inflamed. If this gets bad enough, the intestines can rupture. In those cases, the damaged intestines need to be removed in surgery and can leave scars and longer-term gut problems.
Rare complications are:
- Serious intestinal condition (e.g., toxic megacolon)
- Sepsis
- Death
In the rare case that the bacteria spread from the gut to the blood (bacteremia), they can cause sepsis. This is life-threatening and requires immediate medical attention.
Emotional Issues
Scientific research has found that long-term consequences after CDI include emotional and psychological problems:
- Anxiety, fear, and worry
- Depression
- Isolation, loneliness
- Humiliation and embarrassment
- Collapse of social life
Anger is not uncommon with infections acquired in a healthcare setting. People with these infections express anger about developing an infection as the result of medical treatment for another condition. Others are angry that they were exposed to this infection in a healthcare setting.
Fears about C. diff infections returning are very common, as well. According to one study, most people report a fear of recurrence. In fact, 97% of those whose infection cleared and 99% of those who were currently infected reported a fear of the CDI coming back. People also fear that a relapse will be triggered by antibiotics they will need in the future.
Some people report a fear of infecting others.
Financial Burden
C. diff infections are a burden on the U.S. healthcare system as a whole and they are expensive for individual patients due to prolonged care. It’s estimated that C. diff infections cost $6.3 billion per year in the U.S. The average case of CDI acquired in the community costs just over $21,000, and the cost is much higher for cases acquired in a hospital.
There are several different reasons that CDI causes such significant medical expenses. Overall, people with CDI stay longer in the hospital, they are more likely to be treated in the intensive care unit (ICU), and they often need to be readmitted to the hospital.
If CDI recurs, there are additional expenses related to provider visits, lab tests, and medications for treatment. These may add unexpected costs even after your hospital stay.
Difficulty Working
Having CDI can take a toll on your professional life and impact work activities. Around half of the people with CDI say they had to stop working while they were infected.
Even when people return to work, they may not be as productive as before or may have to take additional sick time. A good quarter of people who recover report having to stop working after CDI due to consequences from the episode.
The lack of income while not working adds to the financial burden of CDI as well.
Recurrence
It’s estimated that about 25% of people (or one in four) who have a C. diff infection will experience a repeat infection. This usually occurs within four to eight weeks after the end of treatment.
The recurrence can be a return of the original C. diff germs, or a person can be exposed to different C. diff germs.
People with weakened immune systems are particularly at risk for getting sick from exposure to the C. diff bacterium, even if they have already recovered from a previous infection.
There are several risk factors for recurrent CDI, including:
- Increased age (older adults are at higher risk)
- Being admitted to the hospital in an emergency situation
- Admission for stomach/intestine issues
- Prior dialysis (treatment that takes over some kidney functions)
- Prior chemotherapy (medication to treat cancer)
If CDI comes back once, your risk of recurrent future episodes increases. This happens due to antibiotic resistance—a lack of effectiveness in the antibiotics being used to treat CDI.
For some people with recurrent CDI, fecal microbiota transplant may be recommended. In this highly effective procedure, stool is taken from a donor and placed in the person with recurrent CDI to promote the growth of healthy bacteria.
Prevention
Preventing reexposure to the C. diff bacterial spores is important to lower the risk of recurrence.At home, handwashing and showering with soap and water are the best ways to make sure you are not carrying the C. diff germs on your body.
The CDC recommends using a weakened bleach solution (one part bleach and nine parts water) to disinfect household surfaces. Clothing, bedding, and other laundry items should be washed before being used by other members of the household.
In the future, if you have an infection that requires antibiotics for treatment, be sure to share your C. diff history with your healthcare team. Your provider may make adjustments to the medications you are prescribed. Most importantly, avoid taking unnecessary antibiotics after recovering from C. diff.
Unfortunately, hand sanitizers do not effectively kill the C. diff bacteria, so washing with soap and water is the best way to prevent spreading this germ.
Improving Quality of Life
Having infectious diarrhea from C. diff can have a profound effect on your quality of life. Researchers have identified that a CDI episode can have negative impacts on mobility, self-care, and participation in activities. CDI can also increase pain, anxiety, and depression.
Higher levels of C. diff recurrence lead to physical and psychological quality-of-life issues.
The impacts of CDI last long beyond the actual infection for some patients. The longer they are sick with CDI, the more changes they report to their quality of life. Depending on your recovery, improving your quality of life after CDI can require assistance.
Work with your healthcare team to optimize your medications, participate in rehabilitation to regain strength, and take the time you need to rest and recover.
Summary
Clostridioides difficile (C. diff) infection has effective treatments and is potentially curable. However, recurrence is common, and for some people, their symptoms may linger even after the infection is gone.
When recovering from CDI, you may encounter long-term health problems. These can include physical, psychological, and professional problems in addition to financial burdens.
Maintaining good hygiene can help prevent recurrence. However, medical treatment is needed in some cases.
If you have long-term problems after C. diff, find a healthcare provider who can address them. This may be a person who provides medical care to manage physical symptoms or a mental health therapist who can help with the long-term psychological impacts.
