Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options

Abstract

SUMMARYClostridioides difficile infection (CDI) is one of the major issues in nosocomial infections. This bacterium is constantly evolving and poses complex challenges for clinicians, often encountered in real-life scenarios. In the face of CDI, we are increasingly equipped with new therapeutic strategies, such as monoclonal antibodies and live biotherapeutic products, which need to be thoroughly understood to fully harness their benefits. Moreover, interesting options are currently under study for the future, including bacteriophages, vaccines, and antibiotic inhibitors. Surveillance and prevention strategies continue to play a pivotal role in limiting the spread of the infection. In this review, we aim to provide the reader with a comprehensive overview of epidemiological aspects, predisposing factors, clinical manifestations, diagnostic tools, and current and future prophylactic and therapeutic options for C. difficile infection.

Keywords: Clostridioides difficile; Clostridium infections; antibacterial agents; antibodies, monoclonal; bacteria; bacteriophages; prevention; surveillance.

Fig 1

Milestones in Clostridioides difficile history. CD, Clostridioides difficile.

Fig 2

Potential factors contributing to the higher CDI prevalence in North America compared to Europe.

Fig 3

Approximate risk of CDI development according to different antimicrobials (65, 73–77).

Fig 4

Main clinical features of CDI.

Fig 5

Pseudomembranous colitis with characteristic colon wall thickening and pancolonic involvement. (Image courtesy of Marco Cavallaro, reproduced with permission.)

Fig 6

Yellow-white pseudomembranes irregularly distributed and strongly adhering to the colonic mucosa. (Image courtesy of Lisa Fusaro, reproduced with permission.)

Fig 7

PMC type I pattern with epithelial necrosis of the interglandular surface accompanied by an exudation of fibrin and neutrophils above (hematoxylin and eosin, 20×). (Image courtesy of Iacopo Ghini, reproduced with permission.)

Fig 8

Pseudomembranous colitis type II pattern with more extended focal surface epithelial necrosis and more prominent exudate above (hematoxylin and eosin, 20×). (Image courtesy of Iacopo Ghini, reproduced with permission.)