C. difficile infection: Current treatment options and challenges
Clostridioides difficile infection is a highly contagious disease that affects 500,000 people in the U.S. and results in nearly 30,000 deaths per year.1 In fact, as the most common healthcare-associated infection in U.S. hospitals, the U.S. Centers for Disease Control and Prevention has labeled it an urgent public health threat.2,3 Caring for patients with this infection can be challenging due to the risk of recurrence associated with the current standard of care, potential for progression to severe disease, and limited treatment options available.
One of the most significant challenges C. difficile infection presents is its tendency to come roaring back after initial diagnosis and treatment, beginning a vicious cycle of recurrence. In up to 35 percent of initial cases, recurrence occurs within 8 weeks of diagnosis and up to 65 percent of those patients go on to experience additional recurrences.4,5 Among people with recurrent C. difficile infection, up to 84 percent are hospitalized within one year, with an average of about two separate hospitalizations per patient.6,7
Antibiotics are the go-to treatment for C. difficile infection8,9 with physicians generally prescribing a 10-day course.10,11,12 If the infection returns, they may extend antibiotic treatment for several weeks. While antibiotic treatment may be effective in managing a C. difficile infection, paradoxically it is a risk factor for recurrence. Although antibiotics can wipe out disease-causing bacteria in the body, particularly in the intestines, they can also destroy helpful bacteria living in the gut. 13,14
Because antibiotics can kill off protective bacteria along with those that cause disease, using them may disrupt the delicate balance of microbes in the gut microbiome. This can lead to a state of imbalance called dysbiosis, which has been associated with a range of gastrointestinal diseases, such as irritable bowel syndrome and inflammatory bowel disease. When dysbiosis occurs, it may give harmful bacteria the chance to take hold and grow in the gut. This includes any C. difficile that may not have been wiped out in a previous round of treatment. This is how the cycle of recurrence can begin.14,15
Not only can continued rounds of antibiotics degrade the microbiome, they can also lead to other challenges, including antibiotic resistance. After completing a course of antibiotic treatment, practitioners may offer patients fecal microbiota transplantation (FMT), which is designed to add a diverse mix of microbes back to the gut.15 However, FMT is not approved as a treatment by the U.S. Food and Drug Administration and clinical studies, diagnosis, and treatment protocols are not standardized.16,17 Additionally, there have been case reports of infections with multidrug resistant pathogens with use of FMT products.18,19
As we continue to see C. difficile infection and recurrence among patients, it is clear that a new paradigm for treatment is necessary to break the cycle of recurrence of this vicious disease. The good news is that over the past decade, research on the gut microbiome and C. difficile infection has provided new insights into this complex illness so practitioners are better able to guide patients on their journey back to health. To get the full story on the microbiome, learn more about C. difficile infection and the challenges with current standards of care, visit www.PowerofMicrobiome.com.
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