Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Aug 25, 2016; 6(3): 28-36
Published online Aug 25, 2016. doi: 10.5495/wjcid.v6.i3.28
Challenges in management of recurrent and refractory Clostridium difficile infection
Anne M Meehan, Raseen Tariq, Sahil Khanna
Anne M Meehan, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN 55905, United States
Raseen Tariq, Sahil Khanna, Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN 55905, United States
Author contributions: Meehan AM, Tariq R and Khanna S planned and researched the topic; Meehan AM and Tariq R wrote the paper; Meehan AM and Khanna S revised the paper.
Conflict-of-interest statement: Sahil Khanna serves as a consultant to Rebiotix Inc and Summit Pharmaceuticals.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Sahil Khanna, MBBS, MS, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
Telephone: +1-507-2664347 Fax: +1-507-2840538
Received: March 24, 2016
Peer-review started: March 24, 2016
First decision: April 15, 2016
Revised: May 5, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: August 25, 2016

Clostridium difficile infection (CDI) is the most common nosocomial infection in the United States and is associated with a high mortality. One quarter of patients treated for CDI have at least one recurrence. Spore persistence, impaired host immune response and alteration in the gastrointestinal microbiome due to antibiotic use are factors in recurrent disease. We review the etiology of recurrent CDI and best approaches to management including fecal microbiota transplantation.

Keywords: Clostridium difficile infection, Epidemiology, Outcomes, Treatment, Fecal microbiota transplantation

Core tip: Recurrent Clostridium difficile infection (RCDI) is common and can be difficult to treat. Clostridia spores transmit disease. They are ubiquitous and hard to eradicate. The composition of the gut microbiome plays an essential yet poorly understood role in maintaining overall health, and in protecting against Clostridium difficile (C. difficile) infection. Antibiotic induced dysbiosis of the microbiome is a key contributor to RCDI. Here we review how C. difficile spores and alterations in the microbiome contribute to RCDI.