Role of the intestinal microbiota in resistance to colonization by Clostridium difficile

Gastroenterology. 2014 May;146(6):1547-53. doi: 10.1053/j.gastro.2014.01.059. Epub 2014 Feb 4.


Antibiotic-associated infection with the bacterial pathogen Clostridium difficile is a major cause of morbidity and increased health care costs. C difficile infection follows disruption of the indigenous gut microbiota by antibiotics. Antibiotics create an environment within the intestine that promotes C difficile spore germination, vegetative growth, and toxin production, leading to epithelial damage and colitis. Studies of patients with C difficile infection and animal models have shown that the indigenous microbiota can inhibit expansion and persistence of C difficile. Although the specific mechanisms of these processes are not known, they are likely to interfere with key aspects of the pathogen's physiology, including spore germination and competitive growth. Increasing our understanding of how the intestinal microbiota manage C difficile could lead to better means of controlling this important nosocomial pathogen.

Keywords: Antibiotics; C difficile; Colonization Resistance; Microbial Ecology; Microbiome.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Animals
  • Anti-Bacterial Agents / adverse effects
  • Bile Acids and Salts / metabolism
  • Biological Therapy / methods
  • Clostridioides difficile / growth & development*
  • Clostridioides difficile / metabolism
  • Clostridioides difficile / pathogenicity
  • Disease Models, Animal
  • Dysbiosis
  • Enterocolitis, Pseudomembranous / metabolism
  • Enterocolitis, Pseudomembranous / microbiology*
  • Enterocolitis, Pseudomembranous / prevention & control
  • Feces / microbiology
  • Host-Pathogen Interactions
  • Humans
  • Intestinal Mucosa / metabolism
  • Intestines / drug effects
  • Intestines / microbiology*
  • Microbiota* / drug effects
  • Probiotics / therapeutic use


  • Anti-Bacterial Agents
  • Bile Acids and Salts