Although C. difficile infection can be caused by almost any antibiotic that disrupts the intestinal flora, it’s typically associated with clindamycin use. Patients at high risk for this disorder include those taking many kinds of antibiotics or antineoplastics that have antibiotic activity; candidates for abdominal surgery; immunocompromised individuals; pediatric patients (infections are common in day-care centers); and those in nursing homes.

Other factors that alter normal intestinal flora include enemas and intestinal stimulants. C. difficile may be transmitted directly from patient to patient via contaminated hands of facility personnel (most common) or indirectly through contaminated equipment (such as bedpans, urinals, call bells, rectal thermometers, and nasogastric tubes) and surfaces (such as bed rails, floors, and toilet seats).