Pal, Rusha, Athamneh, Ahmad I.M., Deshpande, Riddhi, Ramirez, Jose A.R., Adu, Kayode T., Muthuirulan, Pushpanathan, Pawar, Shrikant, Biazzo, Manuele, Apidianakis, Yiorgos, Sundekilde, Ulrik Kraemer, de la Fuente-Nunez, Cesar, Martens, Mark G., Tegos, George P., and Seleem, Mohamed N. (2023) Probiotics: insights and new opportunities for Clostridioides difficile intervention. Critical Reviews in Microbiology, 49 (3). pp. 414-434.

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Abstract

Clostridioides difficile infection (CDI) is a life-threatening disease caused by the Gram-positive, opportunistic intestinal pathogen C. difficile. Despite the availability of antimicrobial drugs to treat CDI, such as vancomycin, metronidazole, and fidaxomicin, recurrence of infection remains a significant clinical challenge. The use of live commensal microorganisms, or probiotics, is one of the most investigated non-antibiotic therapeutic options to balance gastrointestinal (GI) microbiota and subsequently tackle dysbiosis. In this review, we will discuss major commensal probiotic strains that have the potential to prevent and/or treat CDI and its recurrence, reassess the efficacy of probiotics supplementation as a CDI intervention, delve into lessons learned from probiotic modulation of the immune system, explore avenues like genome-scale metabolic network reconstructions, genome sequencing, and multi-omics to identify novel strains and understand their functionality, and discuss the current regulatory framework, challenges, and future directions.

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