title: Disruption of the Gut Microbiome: Clostridium difficile Infection and the Threat of Antibiotic Resistance.
abstract: Clostridium difficile is well recognized as the leading cause of antibiotic-associated diarrhea, having a significant impact in both health-care and community settings. Central to predisposition to C. difficile infection is disruption of the gut microbiome by antibiotics. Being a Gram-positive anaerobe, C. difficile is intrinsically resistant to a number of antibiotics. Mobile elements encoding antibiotic resistance determinants have also been characterized in this pathogen. While resistance to antibiotics currently used to treat C. difficile infection has not yet been detected, it may be only a matter of time before this occurs, as has been seen with other bacterial pathogens. This review will discuss C. difficile disease pathogenesis, the impact of antibiotic use on inducing disease susceptibility, and the role of antibiotic resistance and mobile elements in C. difficile epidemiology.
authors.affiliation: Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton 3800, Australia. priscilla.johanesen@monash.edu.
authors.forename: Priscilla A
authors.initials: PA
authors.lastname: Johanesen
authors.affiliation: Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton 3800, Australia. kate.mackin@monash.edu.
authors.forename: Kate E
authors.initials: KE
authors.lastname: Mackin
authors.affiliation: Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton 3800, Australia. melanie.hutton@monash.edu.
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Hutton
authors.affiliation: Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton 3800, Australia. milena.awad@monash.edu.
authors.forename: Milena M
authors.initials: MM
authors.lastname: Awad
authors.affiliation: Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton 3800, Australia. sarah.larcombe@monash.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Larcombe
authors.affiliation: Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton 3800, Australia. jacob.amy@monash.edu.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Amy
authors.affiliation: Infection and Immunity Program, Monash Biomedicine Discovery Institute and Department of Microbiology, Monash University, Clayton 3800, Australia. dena.lyras@monash.edu.
authors.forename: Dena
authors.initials: D
authors.lastname: Lyras
keywords: Clostridium difficile; antibiotic resistance; antibiotic-associated diarrhea; microbiome; microbiota; mobile genetic elements