Clostridium difficile infection

Nat Rev Dis Primers. 2016 Apr 7:2:16020. doi: 10.1038/nrdp.2016.20.


Infection of the colon with the Gram-positive bacterium Clostridium difficile is potentially life threatening, especially in elderly people and in patients who have dysbiosis of the gut microbiota following antimicrobial drug exposure. C. difficile is the leading cause of health-care-associated infective diarrhoea. The life cycle of C. difficile is influenced by antimicrobial agents, the host immune system, and the host microbiota and its associated metabolites. The primary mediators of inflammation in C. difficile infection (CDI) are large clostridial toxins, toxin A (TcdA) and toxin B (TcdB), and, in some bacterial strains, the binary toxin CDT. The toxins trigger a complex cascade of host cellular responses to cause diarrhoea, inflammation and tissue necrosis - the major symptoms of CDI. The factors responsible for the epidemic of some C. difficile strains are poorly understood. Recurrent infections are common and can be debilitating. Toxin detection for diagnosis is important for accurate epidemiological study, and for optimal management and prevention strategies. Infections are commonly treated with specific antimicrobial agents, but faecal microbiota transplants have shown promise for recurrent infections. Future biotherapies for C. difficile infections are likely to involve defined combinations of key gut microbiota.

Publication types

  • Review

MeSH terms

  • Ampicillin / pharmacology
  • Ampicillin / therapeutic use
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Toxins / analysis
  • Bacterial Toxins / blood
  • Clindamycin / pharmacology
  • Clindamycin / therapeutic use
  • Clostridioides difficile / immunology
  • Clostridioides difficile / pathogenicity*
  • Clostridium Infections / diagnosis*
  • Clostridium Infections / epidemiology
  • Clostridium Infections / physiopathology*
  • Diarrhea / etiology
  • Enterotoxins / analysis
  • Enterotoxins / blood
  • Gastrointestinal Microbiome / drug effects
  • Gastrointestinal Microbiome / immunology
  • Humans
  • Risk Factors
  • Sugar Alcohol Dehydrogenases / analysis
  • Sugar Alcohol Dehydrogenases / blood


  • Anti-Bacterial Agents
  • Bacterial Toxins
  • Enterotoxins
  • tcdA protein, Clostridium difficile
  • Clindamycin
  • Ampicillin
  • Sugar Alcohol Dehydrogenases
  • galactitol 2-dehydrogenase