Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Nov 15, 2015; 6(4): 169-180
Published online Nov 15, 2015. doi: 10.4291/wjgp.v6.i4.169
Gastrointestinal dysbiosis and the use of fecal microbial transplantation in Clostridium difficile infection
L Patrick Schenck, Paul L Beck, Justin A MacDonald
L Patrick Schenck, Gastrointestinal Research Group at the Snyder Institute for Chronic Diseases, Cumming School of Medicine, University of Calgary, Calgary AB T2N 4Z6, Canada
Paul L Beck, Gastrointestinal Research Group at the Snyder Institute for Chronic Diseases and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary AB T2N 4Z6, Canada
Justin A MacDonald, Gastrointestinal Research Group at the Snyder Institute for Chronic Diseases and Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, AB, T2N 4Z6, Canada
Author contributions: Schenck LP, Beck PL and MacDonald JA performed the literature review and wrote the paper.
Supported by Canadian Institutes of Health Research, No. MOP#98004.
Conflict-of-interest statement: The authors declare that they have no affiliation with or involvement in any organization or entity with any financial interest in the subject matter or materials discussed in this manuscript.
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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Justin A MacDonald, Professor, Gastrointestinal Research Group at the Snyder Institute for Chronic Diseases and Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary AB T2N 4Z6, Canada. jmacdo@ucalgary.ca
Telephone: +1-403-2108433
Received: June 25, 2015
Peer-review started: June 26, 2015
First decision: August 16, 2015
Revised: August 28, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: November 15, 2015
Processing time: 144 Days and 18.9 Hours
Abstract

The impact of antibiotics on the human gut microbiota is a significant concern. Antibiotic-associated diarrhea has been on the rise for the past few decades with the increasing usage of antibiotics. Clostridium difficile infections (CDI) have become one of the most prominent types of infectious diarrheal disease, with dramatically increased incidence in both the hospital and community setting worldwide. Studies show that variability in the innate host response may in part impact upon CDI severity in patients. That being said, CDI is a disease that shows the most prominent links to alterations to the gut microbiota, in both cause and treatment. With recurrence rates still relatively high, it is important to explore alternative therapies to CDI. Fecal microbiota transplantation (FMT) and other types of bacteriotherapy have become exciting avenues of treatment for CDI. Recent clinical trials have generated excitement for the use of FMT as a therapeutic option for CDI; however, the exact components of the human gut microbiota needed for protection against CDI have remained elusive. Additional investigations on the effects of antibiotics on the human gut microbiota and subsequent CDI will help reduce the socioeconomic burden of CDI and potentially lead to new therapeutic modalities.

Keywords: Human gut microbiota; Antibiotic-associated diarrhea; Fecal microbial transplant; Bacteriotherapy; Dysbiosis

Core tip: Emergent literature demonstrates the critical role of the human microbiota in the susceptibility to Clostridium difficile (C. difficile) infection (CDI). Microbial communities may exert effects on the metabolic composition within the GI tract that influence CDI pathogenesis (e.g., bile salt metabolism). The identification of protective and susceptible human gut microbiomes would enable the development of screening tools to identify at-risk patients. Ultimately, the rational design of probiotic cocktails could assist in attenuating C. difficile transmission in hospital or community settings. Prevention of CDI would lead to decreased morbidity and mortality, as well as reduction of hospitalization time and health care costs associated with treatment.