C.Diff relapse

Q: About what percentage of patients with C. difficile infection have a relapse even if they are not exposed to further antibiotic therapy?

Answer: 20%

About 20% of patients with C. difficile infection have a recurrence of the infection even if they are not exposed to further antibiotic therapy - and even if they finish a course of appropriate treatment. The time interval between the first infection and a recurrence is usually in the first 4 weeks after treatment is ended. Recurrent disease is caused by the germination of residual C. difficile spores that are not killed and remain in the colon after treatment. About 16% of hospitalized patients harbor this bacteria within their colon as inactive spores. 

Clinical significance: Very high vigilance is required for C. diff. Colitis in view of its deadly nature.

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Reference:

Song JH, Kim YS. Recurrent Clostridium difficile Infection: Risk Factors, Treatment, and Prevention. Gut Liver. 2019 Jan 15;13(1):16-24. doi: 10.5009/gnl18071. PMID: 30400734; PMCID: PMC6346998.