An infection with Clostridioides difficile or C. diff bacteria causes watery diarrhea, and once you have it, your risk for reinfection (recurrence) goes up. When you get C. diff infections multiple times in a row, it’s called recurrent C. diff. Your symptoms and problems can get worse each time, but you can take action to prevent future infections.
“Recovery takes time, but with the right strategy, recurrence can often be prevented,” says Akshaya Bhagavathula, PhD, an epidemiologist, researcher, and professor of public health at North Dakota State University in Fargo. Below, learn how to prevent C. diff recurrence and what to do if it returns.
What Is C. diff?
C. diff is a type of bacteria that targets your large intestine or colon. Although it lives in feces, C. diff can end up on toilets, bathtubs, and other objects. The bacteria wait to be picked up by another host. This germ can live on surfaces for years, and once it enters your body it can infect you again.
“Recurrent C. diff” means the infection cleared up but came back. About a third of people who recover from C. diff get it again in the next few months.
Worrying about a possible C. diff infection happening again can cause understandable anxiety, and it can affect your quality of life. But once you know what signs to look for and when to tell your doctor about symptoms, you can rest easier knowing you have a plan.
Symptoms of C. diff
C. diff can cause inflammation in your colon, which can lead to several symptoms including:
- Diarrhea
- Stomach pain
- Swollen abdomen
- Fast heart rate (tachycardia)
- Poor appetite
- Nausea and vomiting
- Fever
Signs of C. diff recurrence
Recurrent C. diff symptoms typically look the same as the ones you get during your first infection. “A general trigger to consider C. diff infection is when there are at least three episodes of watery diarrhea in a 24-hour period,” says Scott Roberts, MD, associate medical director of infection prevention at Yale New Haven Health and assistant professor at Yale School of Medicine in New Haven.
Roberts says his patients with C. diff usually report feeling fine, then suddenly having a lot of diarrhea, sometimes with a fever and belly pain. But not every bout of diarrhea means your C. diff has come back.
“One nuance that’s important: after C. diff, the gut can stay sensitive, so not every loose stool means recurrence,” says Bhagavathula. “What matters is persistence and progression, not just a single bad day.” So let your doctor know if your loose stools don't go away and get worse.
Why Does C. diff Recurrence Occur?
C. diff can come back for many reasons and your risk is higher for recurrence if you're:
- Over 65 years old
- White
- Recently hospitalized
- Living in a nursing home
- Diagnosed with a weak immune system
- Medical history includes cancer
Some studies also show taking acid-suppressing medications like proton-pump inhibitors (PPIs) may cause a higher risk of C. diff infection, Bhagavathula says.
Key reasons for C. diff recurrence
Taking new antibiotics while your gut’s good bacteria (microbiome) are still recovering can sometimes cause recurrence. “The C. diff bug is crafty,” says Bruce Hirsch, MD, a member of the Peggy Lillis Foundation’s Scientific Advisory Board and an infectious disease specialist in Manhasset, New York.
Even after antibiotics have cleared, a leftover but inactive form of C. diff called spores can stay inside your intestine, says Hirsch. Antibiotics don’t get rid of these spores, which can survive outside your body.
“These spores can "wake up" (relapse) after treatment ends, especially if the microbiome is still weak,” says Bhagavathula. When your gut microbiome is unbalanced, also called dysbiosis, it paves the way for C. diff to multiply and grow.
“Anything that could disrupt the normal bacteria in the gut could lead to C. diff taking over,” says Roberts. Antibiotics is the most common reason your gut gets unbalanced, says Roberts, especially antibiotics that destroy both good and bad bacteria in your gut. This type of medicine is called a broad-spectrum antibiotic.
When you can’t avoid antibiotics, keep an eye on any stomach problems that get much worse while taking them or soon after finishing the last dose, says Roberts. Let your doctor know about any problems or changes in symptoms.
How to avoid C. diff recurrence
You can try to prevent C. diff recurrence by washing up frequently and trying to block recurrent C. diff with these tips.
Wash your hands often. The best way to get rid of C. diff on your hands is to wash them with soap and warm water for at least 20 seconds. Hand sanitizer doesn’t destroy C. diff spores, but soap removes them. Wash your hands after every bathroom visit and before you eat.
Shower daily.Bathing with soap and water every day can help flush away germs that may linger on your skin.
Ask about probiotics. Some research suggests taking probiotics may help prevent C. diff infection, but always ask your doctor before trying a new supplement.
Avoid antibiotics if possible. If you tell your doctor about your C. diff history, they may suggest other treatments or another type of antibiotic, says Bhagavathula. But if your doctor says you need antibiotics, take them as prescribed.
If you know you need antibiotics for something else, like a tooth infection, your doctor may give you another antibiotic to prevent C. diff recurrence.
Complications of C. diff Recurrence
If your C. diff returns, it can cause serious symptoms and health problems. Complications can include:
- Sepsis, a blood infection that can be life-threatening.
- Dehydration happens from the loss of too much water and can cause headache, fatigue, and dizziness. Serious dehydration can also damage your kidneys.
- Electrolyte imbalance can happen when key minerals like potassium, sodium, and calcium get out of balance. They all help your body function properly, and dehydration can disrupt how much you have of each.
- Colon perforation is a tear in the wall of your intestine that allows poop (stool) to pass inside your belly (abdomen). This can cause pain and inflammation.
- Toxic megacolon is a rare, serious widening of your bowel that can cause inflammation and destroy important tissues.
- Pseudomembranous colitis (PMC) causes patches of mucus, dead cells, and other tissues on the walls of your intestines, which can make diarrhea and stomach pain worse.
- Ileus causes your intestines to stop moving, so food doesn't get pushed through normally. You can get serious bloating, nausea, vomiting, and lowered appetite.
When to see the doctor
Call your doctor or get medica care right away if you notice symptoms of C. diff:
- Three or more episodes of watery diarrhea in 24 hours
- Blood in your stool
- Severe stomach pain
- Fever
- Fast heart rate
- Fainting
- Confusion
- Drowsiness
- Peeing only small amounts
“Three or more episodes of watery diarrhea in a 24 hour period, fever, and abdominal pain are all symptoms that should be taken seriously and should prompt a call to the doctor,” Roberts says.
C. diff Treatments
Recurrent C. diff treatments target the bacteria through several methods. “We now have targeted antibiotics, monoclonal antibodies, and microbiome-based therapies that can significantly reduce repeat episodes,” Bhagavathula says. Here’s how these therapies work, how you take them, and possible side effects.
Antibiotics for recurrent C. diff
Fidaxomicin (Dificid) and vancomycin (Vancocin plus Firvanq) are approved to treat recurrent C. diff. Your doctor will likely start with fidaxomicin to weaken the bacteria, bursting them. Even though antibiotics are usually your first treatment for C. diff reinfection, they can sometimes damage your gut microbiome.
You may notice common side effects such as:
- Nausea and vomiting
- Belly pain
- Low potassium levels
- Low red blood cells (anemia)
Some doctors may suggest other treatments to boost your colon’s healthy bacteria. And if other treatments aren't working, your doctor might add a monoclonal antibody.
Monoclonal antibody treatment
Bezlotoxumab (Zinplava) is an infusion that you'll get through an IV. The medicine sticks to the bacteria to block C. diff from causing problems. The most common side effects include:
- Nausea
- Fever
- Headache
Fecal microbiota transplants
These medicines contain a type of healthy gut bacteria. They can build up your gut microbiome, which steals resources from the C. diff trying to grow there. The approved treatments include:
- Live fecal microbiota spores - jslm (Rebyota) taken through your rectum
- Live fecal microbiota - brpk (Vowst) taken as four pills each day, for three days in a row, after a laxative
Common side effects for Vowst include:
- Bloating
- Chills
- Constipation
- Diarrhea
- Fatigue
If you take Rebyota, common problems include:
- Belly pain
- Bloating
- Diarrhea
- Gas
- Nausea
It’s rare, but Rebyota can still contain a few donor germs or food allergens and cause serious problems such as:
- Accidental infections from the donor stool
- Serious allergic reactions, including life-threatening anaphylaxis
Some clinical trials treated C. diff using Rebyota and found that most people did not have C. diff recur for at least two years. Rebyota is a liquid stool made from healthy donors, but Vowst cleans the stool, only leaving bacterial spores behind, which greatly lowers your risk for infection or allergic reactions.
Life During and After C. diff Recovery
Your chances are lower for C. diff infection if you clean your clothes, hands, and anything you touch — especially the things you touch most. Bhagavathula suggests cleaning with products that contain bleach because “C. diff spores are resistant to most standard cleaners,” he says.
Environmental control
Check cleaning product labels to see if they kill C. diff spores. If you can’t find one that does, bleach works, too, says Roberts. Try to clean (disinfect) your:
- Door handles
- Electronic devices
- Handles, like on your refrigerator or cabinets
- Toilet seats and flushing levers
- Faucet fixtures
- Bed sheets and towels
- Underwear
One of the best ways to kill germs is to using the hottest water you safely can for cleaning, wear gloves to protect your hands, and wash your hands with soap and water afterward — even if you wore gloves.
Dietary support
The right diet can help your intestines heal after a C. diff infection and put healthy bacteria back into your gut. “Early on, stick with simple, easy-to-digest foods like rice, bananas, toast, and broth,” says Bhagavathula. “Gradually reintroduce fiber-rich foods to help rebuild the microbiome.”
Foods good for your gut bacteria include:
- Whole grains
- Beans
- Fruits and vegetables
- Yogurt with live bacteria cultures
- Pickled vegetables
It’s also best to talk with a nutritionist to find out what's best for your gut. But you may want to skip food and drinks that irritate your colon, like alcohol, sugary drinks, and greasy or spicy meals.
Mental health
C. diff recurrence can bring up many feelings or spark anxiety. “Many patients experience post-infectious gut sensitivity or anxiety around symptoms,” says Bhagavathula. In fact, he says that this C. diff topic often doesn’t get enough attention.
Finding support and sharing what you’re going through can help. “Support, reassurance, and sometimes medical follow-up are important,” says Bhagavathula.
Support organizations for C. diff
Ask your doctor about speaking to a mental health professional. Through connection with others who have recurring C. diff, plus the support of loved ones and a caring medical team, you can manage your recurrent C. diff.
Takeaways
Recurrent Clostridioides difficile (C. diff) is a bacterial infection that comes back within two months after your last one. C. diff spores can live on surfaces for years, and if they get into your body through your eyes, nose, or mouth, you can get infected again. Tell your doctor if you have new diarrhea, which may suggest C. diff recurrence. They may offer treatments like antibiotics, monoclonal antibodies, or fecal microbiota medicines.
C. diff FAQs
How long is a person contagious with C. diff?
You can give C. diff to other people (contagious) for at least 48 hours after you notice symptoms stop. But you may stay contagious for up to four weeks after treatment.
Can you ever fully get rid of C. diff?
You may never fully get rid of C. diff spores because they can survive even after treatment. In fact, you can carry these microbes without having any symptoms.
How soon after having C. diff can you get it again?
You can get C. diff again as early as two weeks after you recover from your last infection.
