Clostridioides difficile pathogenesis and control. [Review]

Chilton, CH.; Viprey, V.; Normington, C.; Moura, IB.; Buckley, AM.; Freeman, J.; Davies, K.; Wilcox, MH.

Clostridioides difficile pathogenesis and control. [Review]

All Authors

Chilton, CH.

Viprey, V.

Normington, C.

Moura, IB.

Buckley, AM.

Freeman, J.

Davies, K.

Wilcox, MH.

LTHT Author

Chilton, Caroline
Normington, Charmaine
Freeman, Jane
Davies, Kerrie
Wilcox, Mark

LTHT Department

Pathology
Microbiology
NIHR Leeds Biomedical Research Centre

Non Medic

Clinical Scientist
Clinical Scientist

Publication Date

2025

Item Type

Journal Article
Review

Abstract

Clostridioides difficile infection (CDI) continues to be a notable burden worldwide, both in terms of patient mortality and morbidity, and the economic costs associated with treatment, diagnosis and management. The epidemiology of C. difficile has changed markedly over the decades, with high CDI rates driven by clinical pressures exacerbated by the severe acute respiratory syndrome coronavirus 2 pandemic, antibiotic resistance and selective pressures caused by antimicrobial use. C. difficile is challenging to diagnose and treat as it forms spores and can persist asymptomatically within the gut. Some strains express multiple virulence factors, including adhesins and toxins. The gut microbiota is crucially important in CDI, as a healthy microbiota is resistant to colonization with C. difficile. Dysbiosis, often caused by antimicrobial exposure, enables C. difficile spores to germinate and produce toxin, causing symptoms that can range from mild diarrhoea to fulminant colitis and death. This Review describes changes in epidemiology and effects on diagnosis, discusses recent breakthroughs in the understanding of pathogenesis and antibiotic resistance and explores the role of microbiota dysbiosis in CDI and novel microbiota therapies in CDI treatment.