The Intersection Between Colonization Resistance, Antimicrobial Stewardship, and Clostridium difficile

Abstract

The indigenous microbiota provides colonization resistance through depletion of nutrients, prevention of access to adherence sites within the gut mucosa, production of inhibitory substances, and stimulation of the host's immune system. The ability to quantify colonization resistance could provide information regarding periods of maximal vulnerability to colonization with pathogens and also allow the identification of mechanisms of restoration of colonization resistance. Methods utilized to determine the composition of the gut microbiota include sequencing technologies and measurement of concentration of specific bacterial metabolites. Use of innovations in the quantification of colonization resistance can expand the role of Antimicrobial Stewardship from prevention of disruption of the indigenous microbiota to restoration of colonization resistance.

Clostridioides difficile infection: microbe-microbe interactions and live biotherapeutics

“…Microbiota protects against C. difficile by competing for nutrients, activating immunity, producing antibiotics, or modulating the gut metabolome ( Horvat and Rupnik, 2018 ; Rosa et al, 2018 ). Additionally, the composition of the gut community influences disease severity.…”

“…Since the key to curing the infection lies in the intact gut microbiota, researchers and clinicians are implementing a two-pronged approach, involving antibiotics to remove the pathogen, followed by biotherapeutics to replenish the gut microbiota. Microbiota protects against C. difficile by competing for nutrients, activating immunity, producing antibiotics, or modulating the gut metabolome (Horvat and Rupnik, 2018;Rosa et al, 2018). Additionally, the composition of the gut community influences disease severity.…”

Book review: “Clostridioides difficile: Infections, Risk Factors, Prevention and Treatment” by Henning Sommermeyer and Jacek Piątek

“…With healthcare being at the edge of losing the power of antibiotic therapy, interest in alternative approaches to stop the spread of bacterial infections by alternative approaches has recently risen sharply. Among these is the support of the colonization resistance provided by the gut microbiota, which under normal circumstances prevents the proliferation of pathogenic bacteria [3]. Strengthening of the colonization resistance can be achieved by administration of products containing probiotic bacteria without (probiotics) or with a prebiotic (synbiotics) component.…”