PDF(Pubmed)
Abstract：
Clostridioides difficile infection (CDI) may recur in approximately 10-30% of patients, and the risk of recurrence increases with each successive recurrence, reaching up to 65%. C. difficile can form biofilm with approximately 20% of the bacterial genome expressed differently between biofilm and planktonic cells. Biofilm plays several roles that may favor recurrence; for example, it may act as a reservoir of spores, protect the vegetative cells from the activity of antibiotics, and favor the formation of persistent cells. Moreover, the expression of several virulence genes, including TcdA and TcdB toxins, has been associated with recurrence. Several systems and structures associated with adhesion and biofilm formation have been studied in C. difficile, including cell-wall proteins, quorum sensing (including LuxS and Agr), Cyclic di-GMP, type IV pili, and flagella. Most antibiotics recommended for the treatment of CDI do not have activity on spores and do not eliminate biofilm. Therapeutic failure in R-CDI has been associated with the inadequate concentration of drugs in the intestinal tract and the antibiotic resistance of a biofilm. This makes it challenging to eradicate C. difficile in the intestine, complicating antibacterial therapies and allowing non-eliminated spores to remain in the biofilm, increasing the risk of recurrence. In this review, we examine the role of biofilm on recurrence and the challenges of treating CDI when the bacteria form a biofilm.
摘要：
艰难梭菌感染（CDI）可能在大约10-30％的患者中复发，并且复发的风险随着每次连续复发而增加，达到65%。艰难梭菌可以形成生物膜,其中约20%的细菌基因组在生物膜和浮游细胞之间表达不同。生物膜扮演着可能有利于复发的几个角色；例如，它可以作为孢子的水库，保护营养细胞免受抗生素的影响，有利于持久细胞的形成。此外，几个毒力基因的表达，包括TcdA和TcdB毒素,与复发有关。已经在艰难梭菌中研究了与粘附和生物膜形成相关的几种系统和结构，包括细胞壁蛋白，仲裁感应（包括LuxS和Agr），环状双GMP,IV型菌毛,和鞭毛.推荐用于治疗CDI的大多数抗生素对孢子没有活性，也不能消除生物膜。R-CDI的治疗失败与肠道中药物浓度不足和生物膜的抗生素抗性有关。这使得在肠道中根除艰难梭菌具有挑战性，使抗菌疗法复杂化，并允许未消除的孢子保留在生物膜中，增加复发的风险。在这次审查中,我们研究了生物膜对复发的作用以及细菌形成生物膜时治疗CDI的挑战。
