Healthcare-Associated Infections: Clostridioides difficile

Reportable by Laboratories and Providers

About this Reportable Healthcare-Associated Infection (HAI)

Infectious agent:  Clostridioides difficile

Description of illness: Clostridioides difficile (C. difficile) is a bacterium that causes inflammation of the colon, known as colitis. Symptoms include: watery diarrhea (at least three bowel movements per day for two or more days), fever, loss of appetite, nausea, and abdominal pain/tenderness. Clostridioides difficile is shed in feces. Any surface, device, or material (e.g., toilets, bathing tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the Clostridioides difficile spores. Clostridioides difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item. Clostridioides difficile can live for long periods on surfaces.

This disease/condition should be reported through the National Healthcare Safety Network (NHSN).

Laboratory Reporting for this Disease

Clostridioides difficile 

TEST NAME Clostridioides (Clostridium) difficile  
DISEASE/DISORDER Colitis, pseudomembrane colitis  
ALTERNATE NAME(S) C. difficile, C.diff, Antibiotic-associated diarrhea, Antibiotic-associated pseudomembranous colitis  
METHODOLOGY Culture  
SPECIAL INSTRUCTIONS

CEDEP approval required prior to isolate submission.

  
ORDERING INFORMATION Lab Web Portal  

Specimen Requirements

Patient Preparation
  • None
  
Specimen Collection
  • Stool: 

- C&S Culture Transport Media (i.e. ParaPak)

- Semisolid or liquid transport media (i.e. Cary Blair or Amies)

- Commercially available enteric transport medium  

  • Isolate:

- Media that maintains anaerobic conditions (i.e. chopped meat broth, thioglycolate broth)

- Commercially available anaerobic transport media/system

  
Specimen Labeling
  • Specimen should be labeled with at least two unique patient identifiers along with specimen source and match accompanying test order.
  
Specimen Processing
  • None
  
Specimen Storage and Preservation
  • Stool specimens and isolates should be stored at ambient conditions.
  
Specimen Transport
  • Ship stool specimens and isolates in ambient conditions.
  • All infectious substance shipments must conform to U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR 49 C.F.R. Parts 171-180). 
  
Specimen Acceptability and Rejection
  • Formed feces for Clostridioides difficile is not clinically indicated 
  • Specimens that do not adhere to all specimen requirements will be rejected.
  
Testing Location
  • Nashville
  

Laboratory Reporting

Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.

Information about this Reportable Healthcare-Associated Infection (HAI) for Healthcare Providers

Clinical Summary

  • Clostridioides difficile (C. diff) is a bacterium that causes diarrhea and colitis, often after antibiotic use. 
  • Infection can be healthcare‑associated (hospitals, long‑term care) or community-acquired.
  • Symptoms range from mild watery diarrhea, fever, and abdominal pain to severe colitis, toxic megacolon, or sepsis.
  • Recurrent infection occurs in 20–30% of cases and complicates recovery. 
  • Treatment includes targeted antibiotics (vancomycin, fidaxomicin), stopping inciting antibiotics, supportive care, and infection‑control measures to prevent spread. 

Healthcare Provider Reporting

Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.

Providers must report cases of all diseases and conditions listed through one of these methods:

• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857

• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.

• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting. 

• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link. 

Information about this Reportable Healthcare-Associated Infection (HAI) for the Public

What it is

C. diff is a bacterium (formerly known as Clostridium difficile) that causes diarrhea and colitis (inflammation of the colon).

It is a major cause of antibiotic‑associated diarrhea and a leading healthcare‑associated infection. 

Infection often occurs after disruption of the normal gut microbiota, most commonly following antibiotic use.

C. diff spores can persist in the environment, making transmission in healthcare settings a particular concern.

It can range from mild illness to life‑threatening disease, especially in older adults or in those with other health problems. 

Types

There isn’t a formal “phase” classification (acute vs chronic) like some infections, but clinically you can conser:

  • Initial infection: first occurrence of symptomatic C. diff infection (CDI).
  • Recurrent infection: after treatment, many patients (≈20‑30 %) will have at least one recurrence.

Severity levels vary: from mild, self‑limited diarrheal illness to severe colitis, toxic megacolon or sepsis.

Healthcare vs community onset: infections happening in hospitals or long‑term care vs those acquired outside. 

Signs and Symptoms

Typical symptoms: watery diarrhea (often several loose stools per day), fever, abdominal pain or tenderness, and loss of appetite. 

In more severe cases: rapid heart rate, weight loss, nausea, blood or pus in the stool, possible kidney failure, or signs of toxic megacolon. 

Symptoms usually begin during or shortly after antibiotic use, but may appear days to weeks later. 

Because it’s often healthcare‑associated, signs may appear in hospitalized or recently hospitalized patients. 

Recurrent infection may present similarly, complicating recovery and treatment. 

Treatment

Primary treatment is specific antibiotics targeting C. diff (e.g., oral vancomycin, fidaxomicin) rather than the initial broad‑spectrum antibiotics that may have triggered the infection. 

Stopping or changing the inciting antibiotic (if possible) is part of management.

For recurrent infections, additional options may include newer therapies, antibody treatments or microbiome‑based interventions (e.g., fecal microbiota transplant) though these are more specialized.

Supportive care (hydration, electrolyte balance) is important, especially in severe illness.

Prevention of spread and minimizing recurrence (via infection control, antimicrobial stewardship, environment cleaning) is critical.

This Page Last Updated: March 25, 2026 at 8:53 PM