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Review
. 2014 Jun 21;20(23):7416-23.
doi: 10.3748/wjg.v20.i23.7416.

Recurrent Clostridium difficile infections: the importance of the intestinal microbiota

Marie Céline Zanella Terrier  1 , Martine Louis Simonet  1 , Philippe Bichard  1 , Jean Louis Frossard  1
Affiliations
Review

Recurrent Clostridium difficile infections: the importance of the intestinal microbiota

Marie Céline Zanella Terrier et al. World J Gastroenterol. .

Abstract

Clostridium difficile infections (CDI) are a leading cause of antibiotic-associated and nosocomial diarrhea. Despite effective antibiotic treatments, recurrent infections are common. With the recent emergence of hypervirulent isolates of C. difficile, CDI is a growing epidemic with higher rates of recurrence, increasing severity and mortality. Fecal microbiota transplantation (FMT) is an alternative treatment for recurrent CDI. A better understanding of intestinal microbiota and its role in CDI has opened the door to this promising therapeutic approach. FMT is thought to resolve dysbiosis by restoring gut microbiota diversity thereby breaking the cycle of recurrent CDI. Since the first reported use of FMT for recurrent CDI in 1958, systematic reviews of case series and case report have shown its effectiveness with high resolution rates compared to standard antibiotic treatment. This article focuses on current guidelines for CDI treatment, the role of intestinal microbiota in CDI recurrence and current evidence about FMT efficacy, adverse effects and acceptability.

Keywords: Clostridium difficile infection; Clostridium difficile recurrence; Fecal microbiota transplantation; Microbiota; Stool transplantation.

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Figures

Figure 1
Figure 1
Colonoscopy showing typical yellow pseudomembranes that cover superficial mucosal ulcerations.
Figure 2
Figure 2
Algorithm for treatment of Clostridium difficile infections (adapted from[1,10,11]). iv: Intravenously; NGT: Nasogastric tube; CDI: Clostridium difficile infection.
Figure 3
Figure 3
Algorithm for treatment of recurrent Clostridium difficile infections (adapted from[1,10,11]). eod: Every other day.
Figure 4
Figure 4
Perturbation of intestinal microbiota by antibiotics allowing Clostridium difficile infection and fecal microbiota transplantation effect (adapted from[27]). A: Antibiotic use destroys some sensitive bacteria and reduces the microbiota diversity and resistance to colonization by opportunistic pathogens; B: In the absence of opportunistic infection, microbiota usually recover its homeostasis; C: Clostridium difficile (C. difficile) infection can lead to persistent dysbiosis; D: Fecal microbiota transplantation restores microbiota diversity and colonization resistance and allows the elimination of C. difficile.
See this image and copyright information in PMC

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