Prevention of Clostridium difficile Infection and Associated Diarrhea: An Unsolved Problem

Abstract

For many years, it has been known that Clostridium difficile (CD) is the primary cause of health-care-associated infectious diarrhea, afflicting approximately 1% of hospitalized patients. CD may be simply carried or lead to a mild disease, but in a relevant number of patients, it can cause a very severe, potentially fatal, disease. In this narrative review, the present possibilities of CD infection (CDI) prevention will be discussed. Interventions usually recommended for infection control and prevention can be effective in reducing CDI incidence. However, in order to overcome limitations of these measures and reduce the risk of new CDI episodes, novel strategies have been developed. As most of the cases of CDI follow antibiotic use, attempts to rationalize antibiotic prescriptions have been implemented. Moreover, to reconstitute normal gut microbiota composition and suppress CD colonization in patients given antimicrobial drugs, administration of probiotics has been suggested. Finally, active and passive immunization has been studied. Vaccines containing inactivated CD toxins or components of CD spores have been studied. Passive immunization with monoclonal antibodies against CD toxins or the administration of hyperimmune whey derived from colostrum or breast milk from immunized cows has been tried. However, most advanced methods have significant limitations as they cannot prevent colonization and development of primary CDI. Only the availability of vaccines able to face these problems can allow a resolutive approach to the total burden due to this pathogen.

Regulation of Enteric Infection and Immunity by Dietary Proanthocyanidins

“…rotavirus) cause widespread disease and stunt socio-economic development ( 12 ). These infections are less common in high income countries but infections with pathogens such as Clostridioides difficile still pose a considerable public health burden ( 13 ). Notably, lifestyle factors such as poor diet (high sugar/high fat) and lack of exercise may not only lead to metabolic diseases, such as type 2-diabetes, but may also predispose to opportunistic infections due to dysfunctional mucosal barrier function ( 14 ).…”

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

“…Other vaccine candidates are in early development. The challenge for C. difficile vaccines is the choice of a high-risk target population (high-risk antibiotics, advanced age, and/or immunocompromised) and the need to administer the vaccine sufficiently early to obtain protective antibody titers before a triggering event (such as hospital admission or antibiotic administration) [ 110 ].…”

“…Probiotics have been investigated as a method to restore the disrupted microbiome. Some single-strain and multi-strained blends of probiotics have a long history of use and show evidence-based efficacy for the prevention of antibiotic-associated diarrhea (AAD), of which CDI is part of the AAD spectrum [ 47 , 110 ]. Evidence for efficacy is typically determined based on two phase 3 RCTs with a CDI as the primary outcome.…”

Molecular epidemiology and clinical characteristics of Clostridioides difficile infection in patients with inflammatory bowel disease from a teaching hospital

“…In this study, most patients with IBD were younger than 60 years old and the comorbidity burden rate was very low, which is different from the general CDI population. 34 , 35 , 36 In the general population, clindamycin, extended‐spectrum cephalosporins and fluoroquinolones have been reported to be associated with CDI. 35 Similar antibiotics were prescribed in 21.5% of IBD cases in this study.…”