Management ofClostridioides difficilecolitis: insights for the gastroenterologist

Abstract

Clostridioides difficile infection (CDI) is a common cause of diarrhea in both inpatient and outpatient settings. The last few years have seen major changes in the treatment spectrum of CDI, most notably, recommendations against using metronidazole for initial CDI, the addition of fidaxomicin and bezlotoxumab, and emergence of microbial replacement therapies. Several other therapies are undergoing clinical trials. This narrative review focuses on the treatment of CDI with a summary of literature on the newer modalities and the treatment guidelines issued by Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Diseases.

Outcomes in Patients with SARS-CoV-2 and Clostridioides difficile Coinfection

“…3,4 A common side effect of these antimicrobials is diarrhea and C. difficile infection (CDI). 5 Additionally, it has been discovered that bacterial coinfections can occur when the coronavirus is being eradicated from the patients' lungs as the adaptive immune reaction towards the virus fails the reaction of innate immunity against bacterial infection. 6 The SARS-CoV-2 utilizes the angiotensin converting enzyme-2 (ACE-2) receptor for cellular entry, which is expressed on colonocytes.…”

Interplay of intestinal microbiota and mucosal immunity in inflammatory bowel disease: a relationship of frenemies

“…With the in-depth understanding of intestinal microbiota, FMT has been implemented as a treatment strategy for several diseases, especially for the treatment of multiply recurrent Clostridioides difficile infection. 65 In a randomized controlled study of FMT for active UC, the response rate of the FMT-treated group (24%) at week 7 was significantly higher than that in the placebo group (5%), and the intestinal bacterial diversity of FMT-treated patients was significantly higher than controls. 60 A double-blind, controlled study of patients with active UC who received treatment with fecal enema from healthy volunteers demonstrated that the rate of steroid-free clinical remission and endoscopic remission in the FMT group was higher than that in the placebo group at week 8 [risk ratio = 3.6, 95% confidence interval (CI) 1.1–11.9, p = 0.021], and that the intestinal microbial diversity of patients with UC receiving FMT was also higher compared with that in the placebo group.…”

Microbiota restoration for recurrent Clostridioides difficile: Getting one step closer every day!

“…The restoration of this dysbiosis may also be achieved by transplantation of a diverse bacterial consortium from an individual with no known risk factors for microbial dysbiosis [13]. Transplantation of a bacterial consortium leads to rapid correction of dysbiosis, restoration of a species‐rich metabolism and normalization of the bile acid composition [34]. These factors in turn do not allow further colonization with Clostridioides difficile, reduce sporulation and resolve recurrent CDI (Fig.…”