Book review: “Clostridioides difficile: Infections, Risk Factors, Prevention and Treatment” by Henning Sommermeyer and Jacek Piątek

The invention of antibiotic therapy in 1928 was a milestone in medical history and has saved millions of lives. However, recent developments suggest that mankind is about to lose this powerful tool to combat bacterial infections. Among these concerning developments is the growing spread of pathogenic bacteria that have developed resistance against one or even multiple antibiotics [1]. As of today, the first pathogenic germs have evolved that cannot be reached therapeutically with any of the existing antibiotics. This resistance development is caused by the widespread use of antibiotics. The emergence of antibiotic resistance has been historically countered by the invention of new classes of antibiotics. While this approach has been productive for decades, the recent cessation of development of new antibiotics by the pharmaceutical industry is exposing worldwide healthcare to the severe threat of being overrun by non-treatable bacterial infections in the not too distant future [2].
With healthcare being at the edge of losing the power of antibiotic therapy, interest in alternative approaches to stop the spread of bacterial infections by alternative approaches has recently risen sharply. Among these is the support of the colonization resistance provided by the gut microbiota, which under normal circumstances prevents the proliferation of pathogenic bacteria [3]. Strengthening of the colonization resistance can be achieved by administration of products containing probiotic bacteria without (probiotics) or with a prebiotic (synbiotics) component.
The team of the Microbiota Research Group at Calisia University has focused its research efforts in this area since the inauguration of the group in 2018. In several publications, the scientists have been able to demonstrate that certain products containing probiotic bacterial microorganisms are able to contribute to the clinical management of bacterial infections caused by Salmonella Typhimurium [4], Klebsiella pneumonia [5], and Clostri­dioides difficile [6, 7].
C. difficile infections (CDI) are of growing concern for physicians worldwide. While initially considered to be a problem in the hospital setting, nowadays a significant proportion of CDIs originate from the community [8]. Mutations have not only resulted in the emergence of highly virulent strains (e.g. C. difficile ribotype R027) but also in strains that exhibit a broad set of resistances against major classes of antibiotics. In the meantime, C. difficile strains have been identified that are resistant to metronidazole and vancomycin, which until recently were the two remaining effective antibiotics against multi-drug resistant C. difficile [9].
Two members of the Microbiota Research Group in Kalisz, Sommermeyer and Piątek, took on the challenge of summarizing current scientific knowledge about C. difficile in a book published in October 2021 by Springer Nature Switzerland AG. With C. difficile being a potential issue for nearly everyone working in healthcare, be it in a hospital or in a community setting, knowing about key features of the C. difficile microorganism and its potentially devastating effects in patients is of importance.
For the convenience of the readers the authors structured the book into separate chapters each addressing a particular aspect of C. difficile and the infections caused by this pathogen. Each chapter provides a comprehensive summary of current knowledge and is supported by a number of excellent figures. At the end of each chapter is an extensive list of references allowing the interested reader to delve deeper into the topic.
The chapter “Microbiology of C. difficile” sets the stage for the following chapters and provides highly interesting insights into the genetics and the life cycle of the spore-forming C. difficile bacterium during CDI. The chapter “Pathophysiology of C. difficile” provides all the information required to understand how C. difficile can cause disease, with a fascinating insight into the actions of the toxins excreted by this bacterium. A historical perspective of epidemiological developments is provided in the subsequent chapter, which sheds light on the emergence of hypervirulent and multi-drug resistant strains of C. difficile. What follows is an overview of the risk factors associated with C. difficile infections, which comprises, among others, staying in hospital or other medical service units, antibiotics, proton pump inhibitors, and advanced age. The final four chapters cover the “Diagnosis of CDI”, its “Clinical picture”, and options for “Treatment” and “Prophylaxis”. The last two chapters place special emphasis on the potential role synbiotics can play in the management of CDI.
For physicians and other healthcare professionals it is important to be aware that the risk of CDI is always present. The authors stated in their general outlook at the end of the book that “Good knowledge of a problem can strongly contribute to a successful management of a problem”. Reading the book “Clostridioides difficile: Infections, Risk Factors, Prevention and Treatment” can contribute to gaining this important knowledge. The book is available as paperback (ISBN 978-3-030-81099-3) or e-book (ISBN 978-3-030-81100-6) [10].

DISCLOSURE

The author reports no conflict of interest.

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