Clostridium difficile and probiotics
- Lisa E Davidson, MD
Lisa E Davidson, MD
- Medical Director, Antimicrobial Support Network
- Carolinas HealthCare System
- Patricia L Hibberd, MD, PhD
Patricia L Hibberd, MD, PhD
- Chief, Division of Global Health
- Massachusetts General Hospital for Children
Clostridium difficile is an anaerobic, gram-positive, spore-forming bacillus that colonizes the intestinal tract after alteration of the normal gastrointestinal flora, usually by antibiotic therapy . Acquisition of spores usually occurs after exposure in the healthcare setting; spores are also ubiquitous in the soil and environment.
The normal gut flora and host immune responses work together to prevent spore germination, spore proliferation, and toxin production. Exposure to antibiotics is the most common risk factor resulting in development of active disease due to disruption of the gut microbiome and host immune responses.
C. difficile causes a range of illness from mild diarrhea to pseudomembranous colitis and death. The frequency and severity of C. difficile–associated diarrhea (CDAD) are increasing as are relapsed disease and infection refractory to standard antibiotic therapy. (See "Clostridium difficile in adults: Epidemiology, microbiology, and pathophysiology" and "Clostridium difficile infection in adults: Clinical manifestations and diagnosis" and "Clostridium difficile in adults: Treatment".)
Probiotics are live, nonpathogenic bacteria capable of colonizing the colonic mucosa . Most probiotics are sold in fermented foods or dairy products as formulations. The most common probiotics include strains of Lactobacillus or Bifidobacteria, which are part of the normal gastrointestinal microbiota [3-7]. Saccharomyces boulardii is a yeast (fungal) probiotic agent . The alteration of gut microflora in the setting of CDAD has raised interest in a potential role for probiotics to restore a diverse intestinal microflora after disruption by antimicrobial therapy and CDAD .
The role of probiotics for treatment and prevention of C. difficile will be reviewed here. The role of probiotics for antibiotic-associated diarrhea and other gastrointestinal diseases is discussed in detail separately. (See "Probiotics for gastrointestinal diseases".)
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