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Cited by 174Clostridium difficile and Clostridium perfringens researchGut microbiota and healthBacterial Identification and Susceptibility Testing

Clostridium difficile – From Colonization to Infection

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Schäffler, Holger, Breitrück, Anne·2018·Frontiers in Microbiology
DOI 10.3389/fmicb.2018.00646PMC PMC5902504
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Abstract

Clostridium difficile (C. difficile) is the most frequent cause of nosocomial antibiotic-associated diarrhea. The incidence of C. difficile infection (CDI) has been rising worldwide with subsequent increases in morbidity, mortality and health care costs. Asymptomatic colonization with C. difficile is common and a high prevalence has been found in specific cohorts, e.g. hospitalized patients, adults in nursing homes and in infants. However, the risk of infection with C. difficile differs significantly between these cohorts. While CDI is a clear indication for therapy, colonization with C. difficile is not believed to be a direct precursor for CDI and therefore does not require treatment. Antibiotic therapy causes alterations of the intestinal microbial composition, enabling C. difficile colonization and consecutive toxin production leading to disruption of the colonic epithelial cells. Clinical symptoms of CDI range from mild diarrhea to potentially life-threatening conditions like pseudomembranous colitis or toxic megacolon. While antibiotics are the still the treatment of choice for CDI, new therapies have emerged in recent years such as antibodies against C. difficile toxin B and fecal microbial transfer (FMT). This specific therapy for CDI underscores the role of the indigenous bacterial composition in the prevention of the disease in healthy individuals and its role in the pathogenesis after alteration by antibiotic treatment. In addition to the pathogenesis of CDI, this review focuses on the colonization of C. difficile in the human gut and factors promoting CDI.

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  • Clostridioides difficile can be carried asymptomatically throughout life, and only cause problems in older age when the host is immunocompromised and treated with antibiotics.

    “Clostridioides difficile can be carried asymptomatically throughout life, and only cause problems in older age when the host is immunocompromised and treated with antibiotics 19 .”

    From Human microbiome myths and misconceptions (2023) · cites this paper as [19]

    The Asymptomatic Colonization section reports symptom-free carriage in infants and adults, while Extrinsic Risk Factors > Age says infection is more common and more severe in older people and discusses immune responses and antibiotic use as possible contributors (page numbers unavailable). The paper does not establish that an individual carries C. difficile throughout life or that illness occurs only in older, immunocompromised people treated with antibiotics; its Epidemiology of CDI section also reports infection in infants. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • It is not evidence-based to conclude that a characteristic 'pathobiome' has a role in most diseases.

    “It is, therefore, a leap that is not yet evidence-based to conclude that a characteristic 'pathobiome' has a role in most diseases.”

    From Human microbiome myths and misconceptions (2023) · cites this paper as [19]

    The Host Factors section discusses how changes in intestinal microbiota can favor C. difficile infection, and the Conclusion says the progression from colonization to infection is not completely understood. Neither passage addresses whether evidence supports a characteristic pathobiome in most diseases. Searches for “pathobiome most diseases” and for a characteristic disease-associated microbial community found no passage making that broader assessment. (LLM, conf=0.73)

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Cited by

Sorted by citations

Authors
Schäffler, H., & Breitrück, A.
Affiliations
  • University of Rostock (DE)
  • Fraunhofer Institute for Cell Therapy and Immunology (DE)
Corresponding author
Breitrück, Anne
ORCID
Schäffler, Holger
Venue
Frontiers in Microbiology
Publisher
Frontiers Media SA
Published
2018-04-10
Volume
9
Pages
646-646
ISSN
1664-302X (ISSN-L)
DOI
10.3389/fmicb.2018.00646
PMC
PMC5902504
OpenAlex
W2796760994
Cited by
174
References
17
Citations by year
2026: 7 · 2025: 17 · 2024: 23 · 2023: 28 · 2022: 29 · 2021: 21 · 2020: 25 · 2019: 16 · 2018: 7 · 2017: 1
FWCI
2.57
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Microbiology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Publikationsdatenbank der Fraunhofer-Gesellschaft (Fraunhofer-Gesellschaft) (submittedVersion, other-oa)
  • Fraunhofer-Publica (Fraunhofer-Gesellschaft) (submittedVersion)
Funders
Damp Stiftung (2016‐04)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Clostridium difficile and Clostridium perfringens research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
Keywords
Clostridium difficile, Clostridium difficile infection, asymptomatic colonization, pseudomembranous colitis, toxic megacolon, fecal microbiota transplantation, antibiotic-induced dysbiosis, gut microbiota, infection risk factors, nursing home residents, hospitalized patients

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