Chilton, CH orcid.org/0000-0002-8076-1699, Pickering, DS and Freeman, J (2018) Microbiologic factors affecting Clostridium difficile recurrence. Clinical Microbiology and Infection, 24 (5). pp. 476-482. ISSN 1198-743X
Abstract
Background: Recurrent Clostridium difficile infection (rCDI) places a huge economic and practical burden on healthcare facilities. Furthermore, rCDI may affect quality of life, leaving patients in an rCDI cycle and dependant on antibiotic therapy. Aims: To discuss the importance of microbiologic factors in the development of rCDI. Sources: Literature was drawn from a search of PubMed from 2000 onwards with the search term ‘recurrent Clostridium difficile infection’ and further references cited within these articles. Content: Meta-analyses and systematic reviews have shown that CDI and rCDI risk factors are similar. Development of rCDI is attendant on many factors, including immune status or function, comorbidities and concomitant treatments. Studies suggest that poor bacterial diversity is correlated with clinical rCDI. Narrow-spectrum gut microflora-sparing antimicrobials (e.g. surotomycin, cadazolid, ridinilazole) are in development for CDI treatment, while microbiota therapeutics (faecal microbiota transplantation, nontoxigenic C. difficile, stool substitutes) are increasingly being explored. rCDI can only occur when viable C. difficile spores are present, either within the gut lumen after infection or when reacquired from the environment. C. difficile spore germination can be influenced by gut environmental factors resulting from dysbiosis, and spore outgrowth may be affected stage by some antimicrobials (e.g. fidaxomicin, ramoplanin, oritavancin). Implications: rCDI is a significant challenge for healthcare professionals, requiring a multifaceted approach; optimized infection control to minimize reinfection; C. difficile–targeted antibiotics to minimize dysbiosis; and gut microflora restoration to promote colonization resistance. These elements should be informed by our understanding of the microbiologic factors involved in both C. difficile itself and the gut microbiome.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 European Society of Clinical Microbiology and Infectious Diseases. This is an author produced version of a paper published in Clinical Microbiology and Infection. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Antimicrobial persistence; Clostridium difficile; Intestinal microbiota; Recurrence; Spores |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > Institute of Molecular Medicine (LIMM) (Leeds) > Section of Molecular Gastroenterology (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 26 Apr 2018 13:01 |
Last Modified: | 05 Dec 2018 01:39 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.cmi.2017.11.017 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:130102 |