Unifying Concepts

Definitions of Clostridium difficile Infection (CDI)

Clostridium difficile (C. difficile) is a Gram-positive, sporeforming bacterium usually spread by the fecal-oral route. It is non-invasive and produces toxins A and B that cause disease, ranging from asymptomatic carriage, to mild diarrhea, to colitis, or pseudomembranous colitis. CDI is defined as the acute onset of diarrhea with documented toxigenic C. difficile or its toxin and no other documented cause for diarrhea.

Definitions of Clostridium difficile Infection (CDI)
Use of standardized definitions for CDI (health-care onset-health-care facility associated (HO-HCFA), community onset-health-care facility associated (CO-HCFA), community associated (CA), or indeterminate disease (ID) will allow comparison among studies.

Type of case Definition
Health-care facility-onset health-care facility associated (HO-HCFA) Occurs when onset of symptoms 3 days after admission to a health-care facility.
Community onset healthcare facility associated (CO-HCFA) Onset of symptoms within 4 weeks after being discharged from a health-care facility.
Community associated (CA) Occurs when onset of symptoms occurs outside a health-care facility or < 3 days after admission to a health-care facility and has not been discharged from a healthcare facility in the previous 12 weeks.
Indeterminate or unknown onset (ID) CDI develops after being discharged from a health-care facility 4 – 12 weeks previously.
Recurrent CDI Episode of CDI that occurs 8 weeks after the onset of a previous episode, provided the symptoms from the previous episode resolved.



  1. Surawicz CM, Brandt LJ, Binion DG, Ananthakrishnan AN, Curry SR, Gilligan PH, McFarland LV, Mellow M, Zuckerbraun BS. Guidelines for diagnosis, treatment, and prevention of Clostridium difficile infections. Am J Gastroenterol. 2013 Apr;108(4):478-98. [Medline]
  2. Bagdasarian N, Rao K, Malani PN. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA. 2015 Jan 27;313(4):398-408. [Medline]


Created Jan 05, 2017.

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