Control of Clostridium difficile Infection by Defined Microbial Communities

Abstract

Summary Each year in the United States, billions of dollars are spent combating almost half a million Clostridium difficile infections (CDI) and trying to reduce the ~29,000 patient deaths where C. difficile has an attributed role (1). In Europe, disease prevalence varies by country and level of surveillance, though yearly costs are estimated at €3 billion (2). One factor contributing to the significant healthcare burden of C. difficile is the relatively high frequency of recurrent C. difficile infections(3). Recurrent C. difficile infection (rCDI), i.e., a second episode of symptomatic CDI occurring within eight weeks of successful initial CDI treatment, occurs in ~25% of patients with 35-65% of these patients experiencing multiple episodes of recurrent disease(4, 5). Using microbial communities to treat rCDI, either as whole fecal transplants or as defined consortia of bacterial isolates have shown great success (in the case of fecal transplants) or potential promise (in the case of defined consortia of isolates). This review will briefly summarize the epidemiology and physiology of C. difficile infection, describe our current understanding of how fecal microbiota transplants treat recurrent CDI, and outline potential ways through which that knowledge can be used to rationally-design and test alternative microbe-based therapeutics.

Identification of Clostridioides difficile-Inhibiting Gut Commensals Using Culturomics, Phenotyping, and Combinatorial Community Assembly

“…The development of defined bacterial mixes that are derived from the healthy microbiota which can resolve CDI may provide an alternative to FMT (11). However, the exact number of species needed in an efficacious defined bacterial mix for CDI remains unknown but has been reported to be in the range of 10 to 33 species when defined bacteriotherapy was tested in a limited number of patients (12,13).…”

Toxigenic Clostridium difficile-mediated diarrhoea in hematopoietic stem cell transplantation in-patients: rapid diagnosis and efficient treatment

“…Although, there are widely used serological methods for screening of the C. difficile toxins in stool samples, real-time PCR detection of the pathogen is significantly more sensitive, specific and rapid. It remarkably improves the proper management of critically infection-susceptible HSCT patients (10).…”

Faecal transplantation and Clostridioides difficile infection

“…The intestinal microbiota of patients with CDI was significantly altered. 37,38 Also, microbiota disorders lead to the advancement of infection with viruses such as hepatitis B virus (HBV) or human immunodeficiency virus (HIV). [39][40][41] mine what a normal or healthy microbiota is.…”