Epidemiology

The chance of developing Clostridium difficile-associated diarrhoea increases with age and in the presence of severe illness. Neonates are frequently colonised by the bacterium, but susceptibility does not arise until one year-of-age.

C. difficile causes approximately 20% of all cases of antibiotic-induced diarrhoea and colonisation is most likely to occur in hospital. 3% of healthy adults are hosts to C. difficile without ill-effect; sporadic overgrowth may account for rare non-antibiotic-related episodes of diarrhoea.

• C. difficile is found in faeces of approximately 3% of healthy adults, 66% of healthy infants, 7% of asymptomatic care-home residents and 20% of elderly patients on long-term wards without causing symptoms of disease (i.e. asymptomatic carriers)
• Clinical infection occurs when the normal flora of the gut is disturbed, usually using antibiotics, enabling C. difficile to grow and produce toxins. The main risk factors are antibiotic use and increased age (also concurrent illness, nasogastric intubation, alteration of gut motility and the use of cytotoxic agents)

Reference:

• PHE (2019). Recommendations for the Public Health Management of Gastrointestinal Infections