Recent Advances in Clostridioides difficile Infection

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Medical Microbiology".

Deadline for manuscript submissions: 31 August 2025 | Viewed by 3412

Special Issue Editor


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Guest Editor
Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: Clostridioides difficile infection; virulence factors; pathogenesis

Special Issue Information

Dear Colleagues,

Clostridioides difficile infection (CDI) is the leading cause of antibiotic-related diarrhea and healthcare-associated infections, as well as a significant cause of morbidity and mortality affecting especially elderly hospitalized patients. Over the past few decades, the incidence, morbidity and mortality associated with CDIs have increased.

Diagnosis of CDI is often difficult and usually based on a clinical history of recent antimicrobial usage and diarrhea in combination with appropriate laboratory tests. Laboratory diagnosis is essential for the detection of toxigenic strains.

CDI’s high recurrence rates, spore generation and antimicrobial resistance are currently significant challenges for the development of new strategies to manage the infection. Antibiotics disrupt the indigenous gut flora, therefore creating an environment that is favorable for recurrent CDI. The restriction of exposure to ‘high-risk’ antibiotics through antibiotic stewardship programs is a potential method for preventing CDIs.

Within the current treatment landscape, antibiotics such as fidaxomicin and vancomycin are still first-line treatments for CDI, but their effectiveness is limited, and novel microbiota-based therapeutic approaches are currently significant challenges to combat the infection.

This Special Issue aims to collect high-quality research articles, review articles and short communications related to various aspects of Clostridioides difficile infection: bacteria–host interactions, pathogenesis, virulence factors, epidemiology, diagnostic procedures, therapy and prevention.

We encourage researchers from relevant fields to contribute papers highlighting the latest updates on Clostridioides difficile infection or invite relevant experts and colleagues to do so.

Dr. Melina K. Kachrimanidou
Guest Editor

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Keywords

  • Clostridioides difficile infection
  • healthcare-associated infection
  • CDI treatment
  • virulence factors
  • pathogenesis
  • host interactions
  • antibiotic resistance

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Published Papers (2 papers)

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Research

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17 pages, 2681 KiB  
Article
Validation of Lyophilized Human Fecal Microbiota for the Treatment of Clostridioides difficile Infection: A Pilot Study with Pharmacoeconomic Analysis of a Middle-Income Country—Promicrobioma Project
by Carolina Hikari Yamada, Gabriel Burato Ortis, Gustavo Martini Buso, Thalissa Colodiano Martins, Tiago Zequinao, Joao Paulo Telles, Luciana Cristina Wollmann, Carolina de Oliveira Montenegro, Leticia Ramos Dantas, June Westarb Cruz and Felipe Francisco Tuon
Microorganisms 2024, 12(8), 1741; https://doi.org/10.3390/microorganisms12081741 - 22 Aug 2024
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Abstract
Background: Clostridioides difficile infection (CDI) represents a prevalent and potentially severe health concern linked to the usage of broad-spectrum antibiotics. The aim of this study was to evaluate a new lyophilized product based on human fecal microbiota for transplant, including cost–benefit analysis in [...] Read more.
Background: Clostridioides difficile infection (CDI) represents a prevalent and potentially severe health concern linked to the usage of broad-spectrum antibiotics. The aim of this study was to evaluate a new lyophilized product based on human fecal microbiota for transplant, including cost–benefit analysis in the treatment of recurrent or refractory CDI. Methods: The product for fecal microbiota transplant was obtained from two donors. Microbiological, viability, and genomic analysis were evaluated. After validation, a clinical pilot study including recurrent or refractory CDI with 24 patients was performed. Clinical response and 4-week recurrence were the outcome. Cost–benefit analysis compared the fecal microbiota transplant with conventional retreatment with vancomycin or metronidazole. Results: The microbiota for transplant presented significant bacterial viability, with and adequate balance of Firmicutes and Bacteroidetes. The clinical response with the microbiota transplant was 92%. In financial terms, estimated expenditure for CDI solely related to recurrence, based on stochastic modeling, totals USD 222.8 million per year in Brazil. Conclusions: The lyophilized human fecal microbiota for transplant is safe and can be an important step for a new product with low cost, even with genomic sequencing. Fecal microbiota transplantation emerges as a more cost-effective alternative compared to antimicrobials in the retreatment of CDI. Full article
(This article belongs to the Special Issue Recent Advances in Clostridioides difficile Infection)
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Review

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29 pages, 2902 KiB  
Review
Exploring the Toxin-Mediated Mechanisms in Clostridioides difficile Infection
by Evdokia Pourliotopoulou, Theodoros Karampatakis and Melania Kachrimanidou
Microorganisms 2024, 12(5), 1004; https://doi.org/10.3390/microorganisms12051004 - 16 May 2024
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Abstract
Clostridioides difficile infection (CDI) is the leading cause of nosocomial antibiotic-associated diarrhea, and colitis, with increasing incidence and healthcare costs. Its pathogenesis is primarily driven by toxins produced by the bacterium C. difficile, Toxin A (TcdA) and Toxin B (TcdB). Certain strains [...] Read more.
Clostridioides difficile infection (CDI) is the leading cause of nosocomial antibiotic-associated diarrhea, and colitis, with increasing incidence and healthcare costs. Its pathogenesis is primarily driven by toxins produced by the bacterium C. difficile, Toxin A (TcdA) and Toxin B (TcdB). Certain strains produce an additional toxin, the C. difficile transferase (CDT), which further enhances the virulence and pathogenicity of C. difficile. These toxins disrupt colonic epithelial barrier integrity, and induce inflammation and cellular damage, leading to CDI symptoms. Significant progress has been made in the past decade in elucidating the molecular mechanisms of TcdA, TcdB, and CDT, which provide insights into the management of CDI and the future development of novel treatment strategies based on anti-toxin therapies. While antibiotics are common treatments, high recurrence rates necessitate alternative therapies. Bezlotoxumab, targeting TcdB, is the only available anti-toxin, yet limitations persist, prompting ongoing research. This review highlights the current knowledge of the structure and mechanism of action of C. difficile toxins and their role in disease. By comprehensively describing the toxin-mediated mechanisms, this review provides insights for the future development of novel treatment strategies and the management of CDI. Full article
(This article belongs to the Special Issue Recent Advances in Clostridioides difficile Infection)
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