Despite ongoing work to combat Clostridioides difficle infections (CDI), there are several challenges to decrease the incidence of these impacting infections. The Centers for Disease Control and Prevention (CDC) notes that in 2022, there were 116.1 cases per 100,000 across a network of hospitals reporting emerging infections in healthcare settings. Underlying conditions were common for those with CDI and 56% of cases had recent antibiotic use within the last 12 weeks.1
Prevention of CDI is uniquely challenging, relying heavily on a multitude of interventions, such as testing, environmental cleaning and disinfection, antimicrobial stewardship, and isolation precautions. As Turner et al noted, “Hospital-onset Clostridioides difficile infection (HO-CDI) remains a leading cause of health care–associated infection in the US, with an estimated incidence of 8.3 cases per 10 000 patient-days." 2
One aspect of CDI prevention is a stronger understanding the role of biofilms in recurrent infections and efficacy of antimicrobials, specifically vancomycin (VAN). A new report in Gut Microbes seeks to address the role and dynamics of symbiotic bioform formation by not only C difficile but also Bacteroides thetaiotaomicron in patients being treated with VAN.3
What You Need to Know
Despite ongoing efforts, preventing Clostridioides difficile infections (CDI) remains difficult due to factors like underlying conditions and recent antibiotic use. The CDC reported 116.1 cases per 100,000 in 2022, highlighting the prevalence of CDI in healthcare settings.
The formation of symbiotic biofilms by C. difficile and Bacteroides thetaiotaomicron in the presence of vancomycin (VAN) is significant.
Understanding the dynamics of these biofilms is crucial for improving CDI treatment. Targeting the symbiotic relationship between C. difficile and B. thetaiotaomicron could enhance the efficacy of VAN and other antimicrobial treatments.
The research team assessed the relationship between the two gut microbes, focusing on the formation of symbiotic microfilm in the VAN environment. Given that C difficile has a propensity for enhancing its capacity to colonize within the gut and even environmental resistance through synergizing with specific microbes, this research is especially important for interventions.3
The team noted that symbiotic biofilm was indeed formed by C difficile and B thetaiotaomicron and was actually higher than each microbe alone in the VAN environment. “ The scanning electron microscope (SEM) combined with confocal laser scanning microscopy (CLSM) results indicated that the symbiotic biofilm was elevated in thickness, dense, and had an increased amount of mixed bacteria, while the fluorescence in situ hybridization (FISH) probe and plate colony counting results further indicated that the symbiotic biofilm had a significant increase in the amount of C difficile cells, and was able to better tolerate the killing of the simulated intestinal fluid.
Taken together, C difficile and B thetaiotaomicron become collaborative in the VAN environment, and targeted deletion or attenuation of host gut B thetaiotaomicron content may improve the actual efficacy of VAN in CDI treatment.”
These findings point to an increasing need to assess and incorporate gut microbiomes and the role of symbiotic biofilms into CDI treatments. As symbiotic biofilm clearly has a role in strengthening C difficile resistance within the gut, this is a relationship we can no longer afford to ignore in the prevention and treatment of CDI.
References
2. Turner NA, Krishnan J, Nelson A, et al. CDC’s Hospital-Onset Clostridioides difficile Prevention Framework in a Regional Hospital Network. JAMA Netw Open. 2024;7(3):e243846. doi:10.1001/jamanetworkopen.2024.3846
3. Yang, J., Rui, W., Zhong, S., Li, X., Liu, W., Meng, L., … Huang, H. (2024). Symbiotic biofilms formed by Clostridioides difficile and bacteroides thetaiotaomicron in the presence of vancomycin. Gut Microbes, 16(1). https://doi.org/10.1080/19490976.2024.2390133
