Clostridioides difficile infection: can diagnosis, treatment and management be optimised?

What are the issues?

Clostridioides difficile (C. difficile) bacteria are commonly found in the human digestive system. In healthy people, the bacteria do not normally cause any harm. However, the use of antibiotics can trigger dysbiosis by killing gut bacteria that keep C. difficile supressed, causing it to multiply to pathological levels. This can lead to a range of symptoms, such as diarrhoea, fever, swelling of the small intestine, sepsis and, in some cases, death. Patients with CDI can face several challenges when getting a diagnosis, as well as undergoing treatment and management of the infection. Healthcare professionals treating CDI also encounter barriers such as suboptimal diagnostic testing, reimbursement and workforce capacity constraints.

RAND Europe was commissioned by Ferring Pharmaceuticals to undertake three independent studies.

Antibiotics are the standard of care treatment for CDI, but they can sometimes paradoxically worsen dysbiosis leading to a vicious cycle of rCDI. Consequently, alternative treatments to address dysbiosis may be beneficial.

Faecal microbiota transplantation (FMT) has become more widely recommended by CDI treatment guidelines as an option for treating and preventing rCDI. FMT involves transferring a healthy donor’s stool sample to a patient with rCDI to address dysbiosis through gut microbiome restoration. Several previous studies have suggested FMT to be safe and effective. However, there are challenges associated with its implementation and administration, including limited capacity within the healthcare system, recruiting and screening donors, and national, regional, and local regulations. Thus, there is a need for further research in this field, to understand how to support good practice in the care of patients with rCDI.

Despite the prominent use of antibiotics in the treatment of both primary CDI and rCDI and our evolving understanding of the importance of the gut microbiome in human health, it is unclear if and how clinicians take into consideration dysbiosis when making CDI diagnosis and treatment decisions. Such decisions have important implications for managing the burden of CDI within and across countries and reducing the risk of antimicrobial resistance — a global threat that is caused by, among other factors, antibiotic overuse and poor antimicrobial stewardship. Further, there is limited knowledge about what patients or their carers know about dysbiosis, as it relates to CDI, and how this informs acceptance of treatments or self-management and prevention of recurrences.

---

Related research