Microbiome-Related and Infection Control Approaches to Primary and Secondary Prevention of Clostridioides difficile Infections

Abstract

Clostridioides difficile infections (CDIs) have decreased in the past years, but since 2021, some hospitals have reported an increase in CDI rates. CDI remains a global concern and has been identified as an urgent threat to healthcare. Although multiple treatment options are available, prevention strategies are more limited. As CDI is an opportunistic infection that arises after the normally protective microbiome has been disrupted, preventive measures aimed at restoring the microbiome have been tested. Our aim is to update the present knowledge on these various preventive strategies published in the past five years (2018–2023) to guide clinicians and healthcare systems on how to best prevent CDI. A literature search was conducted using databases (PubMed, Google Scholar, and clinicaltrials.gov) for phase 2–3 clinical trials for the primary or secondary prevention of CDI and microbiome and probiotics. As the main factor for Clostridium difficile infections is the disruption of the normally protective intestinal microbiome, strategies aimed at restoring the microbiome seem most rational. Some strains of probiotics, the use of fecal microbial therapy, and live biotherapeutic products offer promise to fill this niche; although, more large randomized controlled trials are needed that document the shifts in the microbiome population.

Screening for Asymptomatic Clostridioides difficile Carriage Among Hospitalized Patients: A Narrative Review

“…Innovative methods for preventing CDI are emerging. Prior studies have shown that probiotics and prebiotics can be effective in preventing CDI, particularly in high-risk groups [ 78 , 79 ]. Specifically, certain bacteria like Bacillus clausii and Lactobacillus reuteri are of interest because they produce substances that directly inhibit C. difficile [ 80 , 81 ].…”

Microbiota-Based Therapeutics as New Standard-of-Care Treatment for Recurrent <i>Clostridioides difficile</i> Infection

“…Probiotics in the Prevention of rCDI rCDI is defined as the recurrence of symptoms accompanied by a positive test for C. difficile toxin within 8 weeks of the preceding CDI episode [14]. The reported incidence of rCDI ranges between 15% and 20% [15,16].…”

Environmental and Nutritional Parameters Modulating Genetic Expression for Virulence Factors of Clostridioides difficile

“…Previous research initially focused on effective treatments for CDIs and, as more CDI outbreaks occurred, better strategies to control healthcare-associated outbreaks in hospitals [4]. During the last two decades, the roles of various toxins, risk factors, and the importance of the protective intestinal microbiome have been established [4]. The development of newer tools has expanded the scope of research into the field of genomic expression of virulence factors.…”

“…A greater understanding of the pathogenesis cascade has led to strategies for the prevention and treatment of CDIs based on direct killing of the C. difficile bacterium with antibiotics or methods to restore the protective intestinal Antibiotics 2024, 13, 365 2 of 14 microbiome using probiotics or fecal microbial replacement. However, CDIs remain a global problem, and more innovative strategies to treat CDIs are urgently needed [4,5].…”