A new review in FEMS Microbes focuses on the life cycle of the gastrointestinal pathogen Clostridioides difficile and on possible ways to disrupt it as treatment option. This is the first review published on our new Open Access journal FEMS Microbes. In this #BehindThePaper interview for the #FEMSmicroBlog, we spoke with first author Noah Budi who present the significance of the paper to different audiences, point to further resources on C. difficile, and tell why they chose the Transparent Peer Review option. #FascinatingMicrobes
Can you summarize the significance of the paper for microbiologists in a different field?
Developing new therapeutic options for treating bacterial infections requires in depth knowledge of the intimate relationship between the pathogen and host. Understanding this relationship allows microbiologist to find processes that can be exploited in exploration of better treatment options.
The relationship between the host and Clostridioides difficile is complex and involves disturbances of the gastrointestinal microbiome and metabolomic changes. The life cycle of C. difficile uses these disturbances to establish infection. Our review focuses on the spore form of C. difficile and how we may be able to use aspects of its life cycle to decolonize patients.
Clostridioides difficile spores are the transmission vector between patients and there are currently no treatment options focused on removing them from the patient and preventing dispersal into the environment. Our review also discusses the pros and cons of different treatment methods, their impact on colonization resistance regeneration, and how they influence recurrence rates for patients.
Can you explain the importance of the paper for the general audience?
Our review provides information on the number one hospital acquired infection in the United States. Understanding how patients become susceptible to C. difficile infections, infected, treated, and the risk factors for recurrence are instrumental in preventing further dissemination of this organism into the hospital and community environments.
The antibiotics used for treating infections are effective at mitigating clinical symptoms but do not decolonize patients and can make them fertile ground for relapse and reinfection. Fecal transplants are by far the best option for preventing recurrent disease but efficacy can be removed through subsequent antibiotic exposure. A major focus of the review is how germinants may be used as a decolonization tool in concert with current treatments.
However, this method of decolonization could be risky as germination of a large enough spore population in vivo may lead to substantial toxin production if antibiotics are not in high enough concentrations to prevent outgrowth. This concern requires investigation for safety and efficacy in non-human living systems before it can be tested in patients and is one focus of our laboratories.
Can you summarize the relevance of the paper for policymakers?
Clostridioides difficile infections are a major problem in hospital environments, causing substantial harm to patients as well as increased medical costs. Understanding how the organism spreads between patients, contaminates the hospital environment, and how various treatment options impact recurrence of the disease will allow leadership to evaluate what policies and procedures will benefit patients the most.
Where can interested people find more information or resources?
The Centers for Disease Control and Prevention (CDC) is an excellent source of information for both patients as well as healthcare providers. The 2017 IDSA Clinical Practice Guidelines for C. difficile infections is probably the most comprehensive collection of information on how to evaluate infections, test patients, record cases, and treat infections.
You decided to opt for the Transparent Peer Review route offered by FEMS Microbes. What motivated you to do so, and what are the benefits in your opinion?
We decided to publish reviewers’ comments and our answers along with the paper (available as supplementay data here).
The peer review process is an integral part of science and more important now than ever. Recent non-peer reviewed COVID-19 studies have had devastating consequences, misrepresenting data, omitting critical research limitations, and disrespecting the science that drives our medical communities to thrive.
The reviewers who evaluated this paper are experts in the field and their concerns about possible treatment directions should be available both as edits to the original publication and represented in their own words.
- Read the paper Treatment issues in recurrent Clostridioides difficile infections and the possible role of germinants by Budi et al. (2020) in FEMS Microbes
- Read the inaugural editorial Announcing FEMS Microbes: open science toward a sustainable world by Editors-in-Chief Kimberly Kline, Kathleen Scott and Jana Jass
After finishing Marshfield Clinic Health System’s Residency Track Program, Noah Budi (@pharmerbudi) became an infectious disease research fellow at the University of Wisconsin-Madison School of Pharmacy. He is interested in pharmacogenomics, MRSA combination therapies, the microbiome’s impact on human health, and developing new treatment options that prevent recurrent Clostridioides difficile infections. He is an advocate for using precision medicine to determine effective therapeutics at baseline and developing novel mechanisms for targeting multi-drug resistant pathogens.
About this blog section
The section #FascinatingMicrobes for the #FEMSmicroBlog explains the science behind a paper and highlights the significance and broader context of a recent finding. One of the main goals is to share the fascinating spectrum of microbes across all fields of microbiology. #BehindThePaper interviews aim to bring the science closer to different audiences, and to tell more about the scientific or personal journey to come to the results.
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