Prevention and treatment of C. difficile in cancer patients

Abstract

Purpose of review We provide an update on the recent literature on Clostridioides difficile infection (CDI) in cancer patients. Recent findings Distinguishing between colonization and infection remains challenging in cancer patients. Many patients with negative toxin analysis are still treated for CDI, and some meet criteria for severe cases. The incidence of CDI is high in cancer patients, especially those with haematological malignancies. Disruption of the gut microbiome due to antibiotic consumption, chemotherapy and radiotherapy is the primary factor contributing to CDI development. The severity of CDI in cancer patients is often unclear due to the absence of well-defined severity criteria. Certain microbiome species predominance and specific ribotypes have been associated with worse outcomes. Whole genome sequencing could be helpful for differentiating recurrence from reinfection and exploring potential nosocomial transmission. While certain new drugs such as fidaxomicin or bezlotoxumab show promise, the optimal treatment and prevention strategies for CDI in cancer patients remain uncertain. Faecal microbiota transplantation (FMT) holds potential for reducing CDI recurrence rates. Summary Further studies are needed to provide robust recommendations for diagnosis, grading severity, and therapeutic management of CDI in cancer patients. Recurrences are particularly concerning due to subsequent exposition to CDI risk factors.

Collagenase-producing bacteria are common in anastomotic leakage after colorectal surgery: a systematic review

“…C. difficile can cause sepsis and produce toxins capable of causing gastrointestinal symptoms varying from mild diarrhea to pseudomembranous enterocolitis and toxic megacolon. Patients who received neoadjuvant chemoradiotherapy have an increased risk of developing CDI [ 52 ] and severe dysbiosis of the gut microbiota [ 53 ].…”

Editorial: Global excellence in inflammatory diseases: Latin America 2021

“…Gut microbiome imbalances, frequently found in patients receiving antibiotics, chemotherapy, and radiotherapy, are primary factors contributing to Clostridioides difficile infection (6). Loureiro et al and Costa et al investigated how C. difficile toxins A (TcdA) and B (TcdB) trigger cell death and expression of proinflammatory mediators in enteric glial cells.…”

“…Gut microbiome imbalances, frequently found in patients receiving antibiotics, chemotherapy, and radiotherapy, are primary factors contributing to Clostridioides difficile infection ( 6 ). Loureiro et al.…”