Breaking the Cycle: The Role of Microbiota-Based Biotherapies in the Reduction of Recurrent Clostridioides difficile

Target Audience
This educational activity is designed for gastroenterologists, ID physicians, hospitalists, critical care physicians, pharmacists, and other healthcare providers who treat patients at risk for C. difficile infection.

Activity Purpose
Clostridioides difficile (C. difficile) is a gram-positive bacterium that infects the colon and causes diarrhea, abdominal bloating, and occasionally colitis. C. difficile infection is associated with significant morbidity and mortality, increased healthcare costs, and hospital readmission rates.

The epidemiology and incidence of C. difficile infections have changed over the past decade, and recurrence continues to pose significant burdens on patients, clinicians, and the healthcare system. Recurrent C. difficile infections can occur in up to 35% of patients who previously had C. difficile infection, usually as a result of the disruption of the intestinal microbiota. Recurrent C. difficile infections are associated with longer hospital stays and higher healthcare costs compared with an initial episode. Therefore, clinicians must be familiar with the risk factors for recurrence, as well as treatment options to prevent multiple recurrences to break the cycle. Microbiota restoration therapies including fecal microbiota transplant (FMT) has shown efficacy in treatment of recurrent C. difficile infections by correcting intestinal dysbiosis. However, FMT itself poses some difficulties associated with safety, and novel live biotherapeutic products (LBPs) are under investigation in phase 2 and 3 trials to overcome these limitations. As such, clinicians must be familiar with the assessment of risk factors, updated clinical guidelines, and available treatment options to reduce recurrences and improve patient outcomes.

Learning Objectives
Upon completion of this activity, participants should be able to:

Describe the integral role of the intestinal microbiota in C. difficile infection and the importance of microbiota restoration for prevention of recurrence
Distinguish the benefits and limitations of fecal microbiota transplantation for the treatment and prevention of recurrent C. difficile in patients failing appropriate antibiotic therapy
Analyze clinical trial data on emerging microbiota restoration therapies
Discuss the emerging potential of microbiota restoration therapies for patients with recurrent C. difficile infections