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Clostridioides difficile infections (CDIs) in England have increased by one-third over three years, according to data published by the UK Health Security Agency (UKHSA).
In a research and analysis paper, published on 1 May 2025, the UKHSA revealed that CDI cases increased by 33% between the 2020/2021 and 2023/2024 financial years.
According to the data, the three-year increase in CDI cases follows a year-on-year decrease in rates between the 2007/2008 and 2013/2014 financial years, with stability observed between the 2013/2014 and 2020/2021 financial years.
The UKHSA also found that rises in CDI infections recorded between the 2020/2021 and 2023/2024 financial years took place in all seven UKHSA regions to different extents.
In addition, between January 2024 and December 2024, the highest CDI rates were observed in north west England, with 48.1 cases per 100,000 people.
South west England and the Midlands reported rates of 39.5 and 37.3 cases per 100,000 people, respectively, followed by 34.7 cases per 100,000 people in the east of England and 33.3 cases per 100,000 people in the north east of England and Yorkshire.
South east England reported rates of 29.7 cases per 100,000 people, followed by the London region with 18.3 cases per 100,000 people — the lowest rate of CDI cases observed in all NHS commissioning regions.
C. difficile is a leading cause of healthcare-associated infections, which is easily transmissible in healthcare settings owing to its spores being highly resistant to heat and many disinfectants.
The UKHSA’s ‘English surveillance programme for antibiotic prescribing, usage and resistance report‘, published in November 2024, revealed that there was an increase in overall antibiotic consumption in England in 2023 compared with 2022.
Long waiting times for hospital treatment can also increase the likelihood of antibiotic treatment, sometimes for multiple courses or prolonged periods.
In 2019, the Welsh Betsi Cadwaladr University Health Board reported an almost 40% reduction in C. difficile after cutting antibiotic prescribing.
Commenting on the data, Russell Hope, senior scientist and team lead in the antimicrobial resistance and healthcare acquired infections division at the UKHSA, said: “[The] UKHSA is working alongside partners, including NHS England, to investigate recent increases in C. difficile cases in hospitals and community settings.
“Cases for 2023/2024 mark the highest overall number of cases since 2011/2012; however, levels still remain substantially below the peak year for cases, which was in 2007. It’s likely the current rise is caused by a combination of factors, including an ageing population with increased comorbidities. Work to identify the causes is ongoing, and the appropriate public health action will be taken in response to our findings.
“C. difficile is a leading cause of healthcare-associated infections. It causes infectious diarrhoea, which can increase morbidity, mortality and hospital length of stay, particularly in the elderly and people whose immune systems are compromised. Outbreaks of these infections can be managed through robust infection prevention and control processes and comprehensive surveillance of infection.”
Elizabeth Beech, regional antimicrobial stewardship lead at NHS England — South West, said: “The south west [of England], like all other regions, has had rising CDI case numbers.
“Of the 6 million people living in the south west [of England], our highest proportion of population aged 65 years and over, and the rise in CDIs in this region has been greatest in [older] men.
“NHS England — South West established a regional CDI improvement collaborative in 2021 with the aim of reducing population harm from CDI.
“Data insight and coding, and ultimately a better understanding of the known risk factors, which have included older age, association with healthcare and antibiotic use, we have been able to better identify those most at risk and focus our interventions.”
