Cases of the potentially fatal stomach infection Clostridioides difficile rose by almost 52 per cent in England over five years, reaching 18,957 in 2024/25, analysis of health data suggests.
The infection rate increased across every NHS England region, with the North West recording the highest level at 46.5 cases per 100,000 people. That was up from 28.4 per 100,000 in 2020/21.
The region, which includes Liverpool and Manchester, now has an infection rate around two and a half times higher than London’s. The capital had the lowest rate in 2024/25, at 18.8 cases per 100,000, although this was still a 25 per cent rise over five years.
C. diff infections rise across England
Analysts from clinical research company TrialMed examined five years of data from the UK Health Security Agency.
The South West had the second-highest rate last year, with 37.6 cases per 100,000 residents, compared with 25.6 in 2020/21. The Midlands recorded 36.6 cases per 100,000, up from 21.5.
In the North East and Yorkshire, the rate rose from 25.5 to 34.1 per 100,000. The East of England recorded 33.1 cases per 100,000, compared with 21.7 five years earlier, while the South East rose from 20.4 to 29.4.
Dr Marianne Viljoen, a clinical research physician at TrialMed, said the regional differences could reflect a combination of factors rather than standards of infection prevention alone.
“They are more likely to reflect a combination of demographics, antibiotic prescribing patterns, population health, healthcare usage and the number of higher-risk patients living within those communities,” she said.
C. diff is highly infectious and spreads through tiny spores found in faeces. The spores can survive on surfaces for long periods, allowing people to become infected after touching contaminated surfaces and then their mouths, or by eating contaminated food.
The infection can cause severe diarrhoea more than 15 times a day, as well as fever, loss of appetite, stomach pain and sickness. In about one in seven cases, it can lead to serious complications including peritonitis, a life-threatening infection of the lining of the abdomen.
C. diff is also the leading cause of hospital-acquired diarrhoea. The bacteria may live harmlessly in the bowel, but antibiotics can destroy healthy gut bacteria and allow C. diff to multiply.
People aged over 65 are considered most at risk because they are more likely to have weakened immune systems, become ill and be prescribed antibiotics. The infection can also lead to sepsis.
Concerns over diagnosis and prevention
A survey of more than 1,000 NHS staff found that nearly 80 per cent did not know the hygiene steps needed to protect patients from C. diff. One in five said they did not routinely test hospital patients who developed diarrhoea.
Dr Jane Freeman, secretary of the C. diff Trust and an associate professor in clinical microbiology, said prompt diagnosis depended on healthcare professionals recognising the risk factors and ordering the correct test.
“We need to make sure [they] have the right skills and awareness of C. diff, and that the NHS has the right systems and guidance in place to ensure that patients get the tests they need at the right time wherever they are,” she said.
Dr Freeman said the consequences could extend beyond the initial illness, as treatment for other conditions may be delayed. C. diff returns in around 25 to 30 per cent of people, she added.
NHS guidance advises people with the infection to remain at home until 48 hours after diarrhoea has stopped. Regular handwashing with soap and water, disinfecting toilets after use and washing soiled clothes and bedding separately are also recommended.
