What Is the Main Idea

Clostridioides difficile (C. difficile) is a bacteria that can lead to mild and serious bowel problems. The authors of the free-access research article “Microbiota-Based Therapeutics as New Standard-of-Care Treatment for Recurrent Clostridioides difficile Infection”, published in the journal Visceral Medicine, discuss developing treatment options and the challenges in producing these medicines for regular use and access.

What Else Can You Learn?

You can learn more about bacteria and bacterial spores. You can also read about the microbiome in our bodies.

Take-Home Message

Classical microbiota-based treatments have emerged as the best way to treat reoccurring C. difficile bacterial infection. However, there are complex logistic and medico-legal procedures that need to be overcome before they can be easily and widely used.

What Is Clostridioides difficile?

If you have spent time in hospital, either visiting or as a patient, you may recognize the name of this bacteria. It is known officially in short as C. difficile but can also be casually known as “C. diff”. More and more, it is becoming a difficult infection to avoid, particularly for those who are weakened, on antibiotic treatment, and exposed to many infections in hospital.

The bacteria C. difficile is present in a safe and normal way in the environment and in our bodies, as part of a microbiome.

What Is the Microbiome?

The microbiome is the name for tiny organisms that live together. These include fungi and viruses as well as bacteria like C. difficile. Microbiomes exist naturally in the environment and help keep us healthy. Microbiomes exist on our skin and inside our body (such as in the gut) and are sometimes called “good bacteria”.

What Are C. difficile Bacteria Spores?

Bacteria spores are part of a bacteria lifecycle, similar to seeds produced by a plant. If the bacteria itself is damaged or disturbed, the spores can develop into new but dangerous bacteria cells.

How Can C. difficile Infection Be a Problem?

It is not the presence of this bacteria that causes problems, but the presence of the bacteria’s spores. Although C. difficile usually lives normally and safely in our body, it can be damaged or disturbed when we take antibiotic medicine for an illness. This is called disruption of the microbiome. The spores that can then develop produce toxins (“endotoxins”) that result in bowel problems such as diarrhea and colon inflammation. If the spore infection is not treated, the bowel problems could get so bad that they can endanger a person’s life.

How Is C. difficile Infection Treated?

Ironically, although the use of antibiotic medicine often causes this bacterial spore infection, it is other antibiotic medicines that are mostly used to treat it. However, these do not always work well. About 2 in 3 people who have C. difficile infection will get it again and again. This is called recurrent infection, or rCDI. Fortunately, a new type of medicine has been developed. This medicine is not an antibiotic, but instead focuses on helping the disrupted microbiota to recover. This medicine is called a microbiota-based therapy.

What Are Microbiota-Based Therapies?

These new medicines contain microbiota. However, the source of this microbiota might be shocking. The microbiota are sourced from human stool! Live microbes exist in healthy human stool. Samples can be cleaned, microbes collected from them, and turned into a medicine. This might sound quite disgusting, but the approach is similar to that of blood donation. Several countries already have stool donor and storage bank systems in place and these medicines have already passed safety tests in America.

How Good Are Microbiota-Based Therapies at Treating C. difficile Infection?

Many studies have shown that this type of medicine is much better at treating C. difficile infection than antibiotics or probiotic medicines.

What Are Some of the Challenges in Making This Medicine Easily Available?

Each country must decide how to categorize the medicine, and how to make sure that its development is safe. For example, making sure that there are laboratory facilities. There are also legal rules regarding stool donation and sample storage, for example, developing a system that tests donors to make sure they are disease-free.

Since microbiota-based therapies have been proven to be effective at treating C. difficile, and thus saving lives, it is expected that, with time and effort from many people across the world, these challenges can be overcome.

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