Clostridioides difficile is a spore-forming bacterium that overgrows in the colon when antibiotics wipe out normal gut flora, and its toxins cause colitis. It spreads easily in hospitals and nursing homes, and severe cases can lead to toxic megacolon and death.
Key symptoms
- Three or more loose, watery stools in 24 hours
- Crampy lower abdominal pain
- Fever and loss of appetite
- Nausea and feeling of dehydration
- Recent antibiotics, hospital stay or nursing home residence
What you find on exam
- Fever, fast heart rate and blood pressure
- Lower abdominal tenderness
- Abdominal distension with few bowel sounds suggests ileus
- Signs of dehydration: dry mouth, low urine output
- Review the medication list for antibiotics and proton pump inhibitors
Tests
- Stool test only on unformed stool: GDH antigen with toxin test, or PCR
- Blood count: white cells of 15,000 or more mean severe disease
- Creatinine above 1.5 mg/dL also means severe disease; check lactate
- Abdominal X-ray or CT if distension, ileus or megacolon is suspected
Treatment basics
- Stop the triggering antibiotic if possible
- Oral fidaxomicin or oral vancomycin for 10 days
- Fulminant disease: high-dose oral vancomycin plus IV metronidazole and early surgical consult
- Contact precautions and soap-and-water handwashing, since alcohol gel does not kill spores
- Recurrence: fidaxomicin, vancomycin taper or fecal microbiota therapy
Red flags
- Low blood pressure or signs of shock
- Swollen, tender abdomen with fewer stools, which suggests ileus or megacolon
- Rising white count, rising lactate or rising creatinine
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Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; CDC, Guideline for Isolation Precautions (2007) and PPE sequence. Written by Making Synapses. Making Synapses is not affiliated with these organizations.