Facts on Clostridioides difficile infections



Clostridioides difficile is an anaerobic bacterium, widely distributed in soil and the intestinal tracts of animals. The clinical spectrum of C. difficile infection (CDI) ranges from mild diarrhoea to severe life threatening pseudomembranous colitis. CDI is generally, but not always associated with previous use of antibiotics. The transmission of C. difficile can be patient-to-patient, via contaminated hands of healthcare workers or by environmental contamination. There is an increase of reports of community-acquired CDI in individuals previously not recognised as predisposed.

The burden of healthcare-associated CDIs in acute care hospitals in the EU/EEA was estimated at 123 997 cases annually. In the ECDC point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals 2016-2017 (ECDC PPS), C. difficile was the 6th most frequently detected microorganism among HAIs.

Hospital-based surveillance of CDIs in EU/EEA Member States, using a common European protocol, was launched on 1 January 2016. The protocol enables hospitals and Member States to collect comparable data to guide their practices to prevent and control CDIs. By 31 March 2016, hospitals in at least 20 of the 31 EU/EEA Member States had conducted surveillance using the protocol.

The ECDC directory of online resources for prevention and control of antimicrobial resistance and HAIs contains guidance for prevention and control of CDI published by ECDC, EU/EEA Member States, international and national agencies and professional societies.


The objectives of European surveillance of CDIs are:

  • To estimate the incidence of CDIs in European acute care hospitals;
  • Toassess the burden of CDIs (including that of recurrent CDI cases) in European acute care hospitals;
  • To provide participating hospitals with a standardised protocol to measure and compare their own CDI incidence rates with those reported by other participating hospitals;
  • To assess the adverse outcomes of CDIs including death;
  • To describe the epidemiology of C. difficile at the local, national and European level, including antibiotic susceptibility, PCR ribotype, presence of Clostridioides difficile toxin A (TcdA), Clostridioides difficile toxin B (TcdB) and binary toxin, morbidity and mortality of CDI, and the detection of new/emerging PCR ribotypes.
Page last updated 5 Oct 2023