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When C. diff doesn't look like C. diff, patients pay the price. A new study found that hospitalized patients with atypical Clostridioides difficile infections — those lacking initial diarrhea — waited twice as long for treatment and faced more than double the 90-day mortality risk. Researchers are calling for updated guidelines to formally recognize these non-classic presentations.
Most clinicians associate Clostridioides difficile infection (CDI) with diarrhea — but a new study reveals that nearly 1 in 5 hospitalized CDI cases present without it, and those patients are facing far worse outcomes. Researchers analyzed 467 CDI episodes at an Australian tertiary hospital and found that atypical presentations — defined by symptoms like vomiting, abdominal distension, constipation, delirium, or fever appearing before diarrhea — led to significantly delayed diagnosis and treatment.
The findings, published in Clinical Infectious Diseases, also highlight a largely underappreciated complication: gastrointestinal dysmotility. Nearly a third of patients showed signs of it at diagnosis, and in half of those cases, no other cause could be identified — suggesting CDI itself was driving the gut slowdown, sometimes for up to six weeks.
Why it matters: CDI is already a leading cause of healthcare-associated infections globally. Missing atypical presentations means delayed treatment and preventable deaths. The authors argue that updating clinical guidelines to include delirium, small bowel imaging criteria, and guidance on empiric therapy could meaningfully reduce CDI mortality worldwide.
