Probiotics: insights and new opportunities for Clostridioides difficile intervention

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.

Automated summary

This review discusses the potential of probiotics in preventing and treating Clostridioides difficile infection (CDI) and its recurrence, reevaluates the efficacy of probiotic supplementation as an intervention for CDI, explores lessons learned from probiotic modulation of the immune system, and delves into avenues such as genome-scale metabolic network reconstructions and genome sequencing to identify novel strains and understand their functionality. The current regulatory framework, challenges, and future directions are also discussed.