Clostridioides difficile: guidance, data and analysis

The characteristics, diagnosis, management, surveillance and epidemiology of Clostridioides difficile (C. difficile).

Clostridioides difficile (C. difficile) is a bacterium that’s found in people’s intestines. It can be found in healthy people, where it causes no symptoms (up to 3% of adults and 66% of babies).

C. difficile causes disease when the normal bacteria in the gut are disadvantaged, usually by someone taking antibiotics. This allows C. difficile to grow to unusually high levels. It also allows the toxin that some strains of C. difficile produce to reach levels where it attacks the intestines and causes mild to severe diarrhoea.

C. difficile can lead to more serious infections of the intestines with severe inflammation of the bowel (pseudomembranous colitis). C. difficile is the biggest cause of infectious diarrhoea in hospitalised patients.

You can become infected with C. difficile if you ingest the bacterium (through contact with a contaminated environment or person). People who become infected with C. difficile are usually those who’ve taken antibiotics, particularly the elderly and people whose immune systems are compromised.

Diagnosis and management

Data submission

See also guidance on the diagnosis and reporting of Clostridium difficile.

Clostridium difficile infection objectives, guidance and assessment available on the NHS Improvement website.

Clostridium difficile Infection Surveillance Update available on HCAI data capture system Help and Support page


UK Health Security Agency (UKHSA, formerly Public Health England) has carried out mandatory enhanced surveillance of C. difficile infection since April 2007 for NHS acute trusts; patient-level data of any C. difficile infections are reported monthly to UKHSA. Independent sector (IS) healthcare organisations providing regulated activities also undertake surveillance of C. difficile infection.

Official statistics compliance

We produce Healthcare associated infections (HCAI) mandatory surveillance statistics publications in accordance with the code of practice for official statistics and they are designated as National Statistics. The data-specific documents below describe our compliance with aspects of the Code.

User engagement

The stakeholder engagement summary collates evidence from mandatory HCAI surveillance statistics users and provides:

  • a summary of how the statistics are used
  • views on how provision of the statistics meets the needs of users
  • our actions in response to user feedback

We will update this document as we receive further user feedback.

Read minutes of the HCAI Mandatory Surveillance Stakeholder Engagement Forum.

Updates to this page

Published 1 July 2014
Last updated 20 September 2022 + show all updates
  1. Added open consultation on the guidance, treatment and management of Clostridioides difficile infection.

  2. Replaced name Clostridium difficile with Clostridioides difficile to reflect changes in microbial taxonomy.

  3. Added link to CDI Objectives and Assessment tool on NHS Improvement website.

  4. Updated with links to the 6 June 2016 meeting.

  5. Added MRSA, MSSA and E. coli bacteraemia and C. difficile infection: 30 day all-cause fatality to collection.

  6. First published.