Recurrent Clostridium difficile infection: From colonization to cure

Abstract

Clostridium difficile infection (CDI) is increasingly prevalent, dangerous and challenging to prevent and manage. Despite intense national and international attention the incidence of primary and of recurrent CDI (PCDI and RCDI, respectively) have risen rapidly throughout the past decade. Of major concern is the increase in cases of RCDI resulting in substantial morbidity, morality and economic burden. RCDI management remains challenging as there is no uniformly effective therapy, no firm consensus on optimal treatment, and reliable data regarding RCDI-specific treatment options is scant. Novel therapeutic strategies are critically needed to rapidly, accurately, and effectively identify and treat patients with, or at-risk for, RCDI. In this review we consider the factors implicated in the epidemiology, pathogenesis and clinical presentation of RCDI, evaluate current management options for RCDI and explore novel and emerging therapies.

ProbioticSaccharomyces boulardiiCNCM I-745 prevents outbreak-associatedClostridium difficile-associated cecal inflammation in hamsters

“…In the clinical setting, C. difficile infection is commonly treated with antibiotics such as metronidazole, vancomycin, or fidaxomicin (46). Similar to a previous study using a hamster model (27), vancomycin treatment altered the severity of CDI, reflected by reduced cecal tissue damage and the corresponding histological score in infected hamsters (Fig.…”

“…CLOSTRIDIUM DIFFICILE INFECTION (CDI) is one of the most common infectious diarrheas in hospitals and long-term care facilities in the United States related primarily to the use of antibiotics (46). C. difficile is an anaerobic bacterium that produces two toxins -toxin A and toxin B -that mediate diarrhea, inflammation, and apoptosis of the mucosal epithelium in animals and humans (32).…”

Nutrition and the gut microbiome in the elderly

“…Therefore, CDI is a toxin-mediated disease of the colon with clinical manifestations ranging from asymptomatic colonization or mild, self-limited diarrhea, to fulminant pseudomembranous colitis, toxic megacolon, colonic perforation, sepsis, shock and death. 43 It is well known that, both the characteristics of C. difficile strain and the host s immune response, influence CDI severity, recurrence risk and mortality. 40 Vancomycin and metronidazole have been used as effective treatment for CDI for over 30 y.…”

Bezlotoxumab for Prevention of RecurrentClostridium difficileInfection

“…1,2 After completing initial antibiotic therapy, up to 35% of patients have recurrent C. difficile infection, 3,4 which is more difficult to treat and is associated with more hospitalizations, more severe outcomes, and higher costs than the first infection and a 50 to 60% chance of repeat recurrent infections. 5,6 Currently, no therapy has been approved to prevent recurrent C. difficile infection.Passive or active immunization against C. difficile toxins A and B is protective in animals that are challenged with toxigenic C. difficile, 7-9 which underscores the key importance of the toxins in causing the symptoms of C. difficile infection. The relative biologic importance of toxins A and B in C. difficile infection is controversial, but it may be host species-dependent.…”

“…1,2 After completing initial antibiotic therapy, up to 35% of patients have recurrent C. difficile infection, 3,4 which is more difficult to treat and is associated with more hospitalizations, more severe outcomes, and higher costs than the first infection and a 50 to 60% chance of repeat recurrent infections. 5,6 Currently, no therapy has been approved to prevent recurrent C. difficile infection.…”