Treatment of Clostridium difficile infection (CDI) includes stopping all previous antibiotic therapy, if possible, followed by the use of metronidazole or vancomycin. The main problem is that antibiotic treatment for a first infection eliminates many potentially protective commensal bacteria, facilitating reinfection. Thus, the gut microbiota needs to be restored to protect the intestinal epithelium and to prevent the recurrence of the disease. For this reason non-antibiotic based treatments, such as fecal microbiota transplantation (FMT), have been adopted to treat CDI. Despite the efficacy of FMT, which resolves recurrent CDI in more than 90% of the cases, this treatment has not been formally approved, which restricts its use. Moreover it requires time to identify a suitable donor and carries the risk of unintentional transmission of undetected pathogens, which together with general patient aversion represent major impediments to the broad application of this treatment. Thus, a major goal in the field is to identify specific members of the gut microbiota that can be the basis for an effective, safe and standardized treatment for CDI.
Clostridium difficile relies on the utilization of gut mucosal sugars to expand and cause infection and disease. Using stable isotope probing coupled to Raman Spectroscopy, we could observe stimulation of a significant part of the commensals from the gut mouse community when ammended with the same mucosal sugars that C.difficile utilizes during expansion in the gut. Using Raman-based single cell sorting, these efficient mucosal sugar utilizers were sorted and started to be identified. The ability of these commensal organisms (or closely related ones) to outcompete C. difficile will now be tested in vitro, and if successul results are achieved, then in vivo. If these organims reveal to be able to efficiently compete C. difficile, they can be used as the basis for an new bacterial-based treatment to erradicate C. difficile from the gut. C. difficile is currently a major concern is hospitals and health care institutions. In most European countries the number of deaths caused by CDI has more than quadrupled in the last decade, with medical costs associated with CDI also representing a major economic burden. Thus, the identification of organisms with potential to eradicate this pathogen will benefit the European economy and society in general.