Microbiota Insights in Clostridium Difficile Infection and Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is characterized by chronic intestinal inflammation that includes Crohn´s disease (CD) and ulcerative colitis (UC). Although the etiology is still unknown, some specific factors have been directly related to IBD, including genetic factors, abnormal intestinal immunity, and/or gut microbiota modifications. Recent findings highlight the primary role of the gut microbiota closely associated with a persistent inappropriate inflammatory response. This gut environment of dysbiosis in a susceptible IBD host can increasingly worsen and lead to colonization and infection with some opportunistic pathogens, especially Clostridium difficile. C. difficile is an intestinal pathogen considered the main cause of antibiotic-associated diarrhea and colitis and an important complication of IBD, which can trigger or worsen an IBD flare. Recent findings have highlighted the loss of bacterial cooperation in the gut ecosystem, as well as the pronounced intestinal dysbiosis, in patients suffering from IBD and concomitant C. difficile infection (CDI). The results of intestinal microbiota studies are still limited and often difficult to compare because of the variety of disease conditions. However, these data provide important clues regarding the main modifications and interrelations in the complicated gut ecosystem to better understand both diseases and to take advantage of the development of new therapeutic strategies. In this review, we analyze in depth the gut microbiota changes associated with both forms of IBD and CDI and their similarity with the dysbiosis that occurs in CDI. We also discuss the metabolic pathways that favor the proliferation or decrease in several important taxa directly related to the disease.

Microbiota in Clostridioides difficile-Associated Diarrhea: Comparison in Recurrent and Non-Recurrent Infections

“…With regards to taxonomic composition, our data show that infection by C. difficile is accompanied by significant alterations in the abundance of some taxa, mainly belonging to Firmicutes, generally confirming previous findings of metagenomics works on CDI and contributing to the increase of records [5,10,11,16,[18][19][20]. In our patients, the infected state considered globally (CDI and rCDI1) share most of the significant shifts in microbiota structure, probably also due to the size of the cohorts.…”

“…Our findings highlight the need to further investigate its role in C. difficile infection, while defining which specific members of this cluster increase in abundance. Outside the Clostridium universe, other taxa increased upon infection (CDI and rCDI1) are Enterococcaceae and Enterococcus, as already reported e.g., [5,8,10,18,19].…”

“…Infection by C. difficile is a global and increasingly common public health problem and is considered the major cause of antibiotic-associated diarrhea, especially in healthcare settings and in elderly individuals over the age of 65. CDI has known dramatic increases in severity and incidence over the past decade, with frequent outbreaks, especially in hospitals, reported both in Europe and in the United States [5]. Of growing concern is also the increasing incidence of CDI in categories not traditionally considered "at risk", as children and young adults.…”

“…Recognized risk factors are numerous and include age (>65 years), underlying diseases, gastrointestinal surgery, long-term care residency, previous hospitalization, nasogastric tube feeding and use of drugs like antibiotics, proton-pump inhibitors (PPI) and histamine receptors 2 blockers, [1]. CDI is also often observed as a complication of severe comorbidities, especially intestinal inflammatory conditions as inflammatory bowel disease (IBD), where the association of C. difficile toxins with flares has been suggested [5].…”

Vitamin C Deficiency and the Risk of Osteoporosis in Patients with an Inflammatory Bowel Disease

“…Quantitative and qualitative imbalances of microbiota are associated directly with the severity of the disease [125]. Clinicians made attempts to modify the gut microbiota composition for a clinical and endoscopic improvement [126]. The autoimmune process causing inflammation of the intestinal mucosa is the basis of IBD.…”