Clostridioides (ex. Clostridium) difficile
MICROBIOLOGY
- Spore-forming anaerobe, Gram-positive bacillus [Fig 1].
- Found in human and animal feces, also in water and soils.
- Reclassified in 2016 as molecular sequencing suggests that the organism should be in the Peptostreptococcaceae family and termed Peptoclostridium.
- Clostridioides difficile’s name was selected to differentiate it from Clostridiaspp., which are unrelated but allow for less clinical confusion moving from the long-standing terminology of Clostridium difficile[24].
- Cycles between a hardy spore (transmissible via fecal-oral route) form and a vegetative (metabolically active) form.
- Only strains possessing the Pathogenicity Locus (PaLoc) are capable of toxin production.[43]
- Toxigenic strains can produce toxin A (tcdA) and/or toxin B (tcdB), which causes clinical disease (colitis) when in vegetative form.
- The presence of secondary bile acids, synthesized by a healthy host microbiome, largely inhibits the germination of C. difficile spores in the colon and thus prevents toxin production and disease[39].
- Without signals to germinate, spores can latently colonize the colon, though factors contributing to colonization vs clearance remain under studied.
- Occasionally grown in anaerobic cultures, it is rarely a cause of infection other than colitis.
- Resistance described to metronidazole and high MICs correlates with poorer outcomes[15].
- Increased MICs to vancomycin and fidaxomicin have also been documented, and the former may be associated with poorer clinical outcomes[13][5].
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Last updated: May 10, 2024
Citation
Anderson, Sean Anderson M, and Paul G Auwaerter. "Clostridioides (ex. Clostridium) Difficile." Johns Hopkins ABX Guide, The Johns Hopkins University, 2024. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/Johns_Hopkins_ABX_Guide/540134/3.0/Clostridioides__ex__Clostridium__difficile.
Anderson SM, Auwaerter PG. Clostridioides (ex. Clostridium) difficile. Johns Hopkins ABX Guide. The Johns Hopkins University; 2024. https://peds.unboundmedicine.com/pedscentral/view/Johns_Hopkins_ABX_Guide/540134/3.0/Clostridioides__ex__Clostridium__difficile. Accessed October 13, 2024.
Anderson, S. M., & Auwaerter, P. G. (2024). Clostridioides (ex. Clostridium) difficile. In Johns Hopkins ABX Guide. The Johns Hopkins University. https://peds.unboundmedicine.com/pedscentral/view/Johns_Hopkins_ABX_Guide/540134/3.0/Clostridioides__ex__Clostridium__difficile
Anderson SM, Auwaerter PG. Clostridioides (ex. Clostridium) Difficile [Internet]. In: Johns Hopkins ABX Guide. The Johns Hopkins University; 2024. [cited 2024 October 13]. Available from: https://peds.unboundmedicine.com/pedscentral/view/Johns_Hopkins_ABX_Guide/540134/3.0/Clostridioides__ex__Clostridium__difficile.
* Article titles in AMA citation format should be in sentence-case
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T1 - Clostridioides (ex. Clostridium) difficile
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A1 - Anderson,Sean Anderson,M.D.
AU - Auwaerter,Paul,M.D.
Y1 - 2024/05/10/
BT - Johns Hopkins ABX Guide
UR - https://peds.unboundmedicine.com/pedscentral/view/Johns_Hopkins_ABX_Guide/540134/3.0/Clostridioides__ex__Clostridium__difficile
PB - The Johns Hopkins University
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