A potentially life-threatening gut infection is on the rise across England, with cases increasing by almost 50% in five years.
Data from the UK Health Security Agency (UKHSA) shows that rates of Clostridioides difficile (C. diff) infection rose from 22.2–33.3 cases per 100,000 people between 2020 and 2021 and 2024 and 2025. This is the highest incidence rate recorded since the 2011 and 2012 financial year, with NHS acute trusts reporting 18,970 cases in 2024 and 2025.
The increase has been seen in both hospital and community settings, highlighting the importance of careful antibiotic stewardship alongside robust infection control measures.
Dr Gowda, a clinical research leader at Trialmed, notes that most people do not connect their own antibiotic use with the wider issue. “People hear about C. diff outbreaks and assume it is about dirty hospitals, but the evidence tells a different story. Antibiotic use, not environmental cleanliness, is the single biggest driver of who develops this infection.”
Understanding C. diff and its causes
Dr Gowda, a clinical research leader at Trialmed, notes that most people do not connect their own antibiotic use with the wider issue.
“People hear about C. diff outbreaks and assume it is about dirty hospitals, but the evidence tells a different story. Antibiotic use, not environmental cleanliness, is the single biggest driver of who develops this infection.”
High-risk groups
People are up to 10 times more likely to develop C. diff while taking antibiotics and during the month after completing a course, with longer courses further increasing the risk. Antibiotics do not only target the bacteria causing the original illness; they can also eliminate large sections of the healthy gut microbiome that normally compete with C. diff for space and nutrients.
“Certain antibiotics carry a particularly high risk, including clindamycin, cephalosporins, fluoroquinolones such as ciprofloxacin, and broad-spectrum penicillins, all of which can cause extensive disruption to gut bacteria.”
“If you are already on antibiotics, speak to a doctor if you develop diarrhoea or feel very unwell while taking them, so they can decide whether to adjust treatment or investigate for C. diff.”
The primary groups most at risk include
People aged over 65
“Older adults account for the vast majority of cases, with more than 80% of infections reported in the over-65 age group. This is largely down to a combination of weaker immune defences, more frequent antibiotic exposure through repeat courses for other infections, and greater contact with healthcare settings, all of which can increase the risk of C. diff taking hold.”
People with weakened immune systems
“Those with cancer, organ transplants, or taking immunosuppressant drugs are significantly more vulnerable to infection taking hold. A properly functioning immune system helps limit how much C. diff can multiply and how severe the resulting inflammation becomes, so when that response is suppressed by illness or medication, infections tend to progress further and recovery takes longer.”
Anyone with a previous C. diff infection
“Prior infection raises the risk of recurrence, with relapse occurring in around 20%–30% of patients, and that risk climbs to 40%–60% after a first recurrence. Recurrence happens for two main reasons: dormant spores left behind in the gut after the first infection can germinate again once conditions allow, or a person can be reinfected from a contaminated environment. In most documented cases, however, it is the original strain relapsing rather than a fresh infection.”
Steps to minimise the risk of infection
Only take antibiotics when clinically necessary
Avoiding unnecessary antibiotics is one of the most effective ways to protect the gut’s natural bacterial balance. Depleting protective bacteria, along with the bile acids and nutrients they regulate, can allow C. diff to establish an infection. “Where antibiotics are unavoidable, choosing a narrower-spectrum option and the shortest effective course limits the amount of collateral damage done to the microbiome. If you develop diarrhoea while or after taking antibiotics, that is a reason to contact a GP rather than stopping the tablets on your own.”
Wash hands with soap and water instead of relying solely on hand sanitiser
“C. diff spores have a tough, multi-layered outer coating that alcohol cannot penetrate, meaning alcohol gel can leave a large proportion of spores still viable on the hands even after use. Soap and water works instead through mechanical removal, physically washing spores away from the skin rather than trying to kill them chemically. This is why thorough handwashing after using the toilet and before eating remains the more reliable option.”
Clean surfaces thoroughly in shared or care settings
“C. diff spores can survive on toilets, commodes, and frequently touched surfaces for months because of their resistant outer shell, so regular disinfection is needed to break the chain of transmission. Standard household cleaners are often not enough, and chlorine-based disinfectants are generally required to reliably destroy the spores rather than simply move them around.”
Isolate and use separate facilities where possible
“In hospitals and care homes, patients with confirmed infection should ideally have their own room and toilet, because shared facilities are one of the most direct routes for spores to pass from an infected person to others nearby. At home, the same principle applies on a smaller scale. Where possible, anyone with a confirmed infection should use a separate toilet from the rest of the household. If a separate bathroom isn’t available, the toilet should be thoroughly disinfected after each use, and towels or flannels should not be shared until the person has fully recovered.”
Complete the full course of any prescribed antibiotic treatment
“Stopping treatment early can allow an infection to return, as an incomplete course may fail to fully clear C. diff or the original infection being treated, leaving symptoms more likely to resurface. Relapses tend to occur within the first two weeks after treatment ends, which is why taking the treatment exactly as prescribed, and speaking to a doctor before making any changes, is important for preventing recurrence.”