Management of Clostridioides difficile in IBD patients

Abstract

Clostridioides difficile (C. difficile) is an anaerobic, spore-forming, Gram-positive bacterium. C. difficile is the most frequently reported nosocomial pathogen. C. difficile is also the most commonly identified pathogen associated with antibiotic-associated diarrhea, responsible for up to 30% of antibiotic-associated diarrhea. Spores are transmitted via the fecal-oral route, and acquisition of C. difficile in the healthcare setting is generally by contaminated hands or surfaces. C. difficile has two monoglycosyltransferase virulence factors that are responsible for damage to the intestinal mucosa, enterotoxin A (TcdA) and cytotoxin B (TcdB). These two enzymes enter intestinal epithelium through receptor-mediated endocytosis and irreversibly inactive Rho GTPases. This ultimately disrupts the cytoskeleton and tight junctions, resulting in a loss of parenchymal polarity and eventual apoptosis.