Advances in the Microbiome: Applications to Clostridium difficile Infection

Abstract

Clostridium difficile is a major cause of morbidity and mortality worldwide, causing over 400,000 infections and approximately 29,000 deaths in the United States alone each year. C. difficile is the most common cause of nosocomial diarrhoea in the developed world, and, in recent years, the emergence of hyper-virulent (mainly ribotypes 027 and 078, sometimes characterised by increased toxin production), epidemic strains and an increase in the number of community-acquired infections has caused further concern. Antibiotic therapy with metronidazole, vancomycin or fidaxomicin is the primary treatment for C. difficile infection (CDI). However, CDI is unique, in that, antibiotic use is also a major risk factor for acquiring CDI or recurrent CDI due to disruption of the normal gut microbiota. Therefore, there is an urgent need for alternative, non-antibiotic therapeutics to treat or prevent CDI. Here, we review a number of such potential treatments which have emerged from advances in the field of microbiome research.

Treatment of recurrent Clostridium difficile colitis: a narrative review

“…Mean cure rates in recurrent CDI of 91–96% can be achieved with FMT, indicating that donor faecal transplantation is effective in treating recurrent disease after initial antibiotic therapy [ 52–55 ]. Larger longitudinal studies are required to assess regulatory concerns and long-term adverse events in patients after FMT [ 56 ].…”

Diagnostics and treatment of Clostridium difficile-associated disease: Guidelines of the Russian gastroenterological association

“…Clostridium difficile-ассоциированная болезньзаболевание, которое развивается при нарушении кишечного микробиома с избыточной колонизацией C. difficile, токсины которой вызывают воспаление и повреждение толстой кишки [1][2][3][4][5].…”

Clostridium difficile Infection: Pathogenesis, Diagnosis and Treatment

“…Bioengineering of microorganisms to target specific pathogens has gained popularity in recent years [38]. Up to date, no research has been carried out in this field in relation to C. difficile.…”

“…The donor material is introduced into the patient via rectal enema, a nasoduodenal tube or colonoscopy. An FMT is recommended after a third CDI episode [38]. Kelly et al conducted a randomized trial, in which they selected adults with three or more documented CDI recurrences.…”

“…The long-term consequences of the treatment are also unpredictable. The US Food and Drug Administration (FDA) has classified FMT as a drug and biological product, so that the procedure is subjected to the same regulations as traditional pharmaceutical drugs [38].…”