1. Clostridium difficile Infection Biology & Public Health Impact
Peggy Lillis Memorial Foundation
2017 Summit
Clostridium difficile Infection
Biology & Public Health Impact
Gerard Honig, PhD
Director, Peggy Lillis Foundation
Symbiotic Health Inc.
Crohn’s & Colitis Foundation
(201)

2. Depleted gut bacteria:
C.diff: The Disease
Diverse gut bacteria
prevent infection:
Symbiosis
Antibiotics
Depleted gut bacteria:
C.diff disease
Dysbiosis
Stop antibiotics if feasible
Ge Hong in the 4th century cured patients with food poisoning or severe diarrhea with fecal suspensions from health donors
Li Shizen effectively used fecal therapy for abdominal diseases
In the 17th century, fecal therapy used for ruminants
FMT first reported in 1958 – Dr Ben Eiseman
C.diff
exposure

3. ‘The Bacteria Are Us, We Are the Bacteria’
Here you introduce orally the impact of antibiotics in the microbiome composition, and the effect of that on pathogens, such as C.diff
iii) Importance in personalized medicine (genomic is 99.9 identic)
K. Orvidas
J. Brody
NY Times 2014

4. The Gut Microbiota: A Balanced Community of Essential Bacteria
Here you introduce orally the impact of antibiotics in the microbiome composition, and the effect of that on pathogens, such as C.diff
iii) Importance in personalized medicine (genomic is 99.9 identic)
L. Margulis;
Ursell et al

5. The Microbiota: A Line of Defense Against Infection
Here you introduce orally the impact of antibiotics in the microbiome composition, and the effect of that on pathogens, such as C.diff
iii) Importance in personalized medicine (genomic is 99.9 identic)
B. Christie,
Scientific American 2012

6. Clostridium difficile (C.diff): The Organism

7. How C.diff causes diarrhea

8. The C.diff Lifecycle: Spore Formation
C.diff can reproduce by creating hardy, long-lasting spores
Spores are difficult to kill on surfaces
Spores can reside in the gut and evade antibiotic treatment

9. How the C.diff spreads and evades treatment
Agito et al (2013)

10. How C.diff Spreads
Centers for Disease Control

11. Impact of C.diff
Centers for Disease Control

12. Impact of C.diff 453,000 cases 83,000 first recurrences
¼ community acquired
83,000 first recurrences
29,300 associated deaths
Lessa et al. New England Journal of Medicine 2015
Centers for Disease Control

13. C.diff Hospitalizations (US)
Prevalence of C.diff
C.diff Hospitalizations (US)
Centers for Disease Control
One of the most common hospital-acquired infections.

14. C.diff Hospitalizations (US)
Prevalence of C.diff
C.diff Hospitalizations (US)
Centers for Disease Control
One of the most common hospital-acquired infections.

15. New & more aggressive types of C.diff
Beginning in 2002, a new strain of C. difficile (B1/NAP1/027) emerged in Canada, US & Europe
Incidence in one Canadian region in patients >65:
210/100,000 in 2002
866/100,000 in 2003
Increased mortality and antibiotic resistance
Increasing community-acquired infection

16. C.diff: From nuisance infection to urgent unmet medical need

17. Novel microbe-derived proteins Monoclonal antibodies & Vaccines
Emerging Therapeutic Solutions
Novel microbiome
organisms
Novel microbe-derived proteins
Monoclonal antibodies & Vaccines
Next Generation
Treatments

18. Take home messages
Antibiotics do not cause C.diff, but they can increase risk by injuring healthy gut microbes.
Opportunity for Impact: Antibiotic stewardship
Spread of C.diff exposure is common in healthcare facilities.
Opportunity for Impact: Infection control

19. Take home messages C.diff is a major public health crisis.
Opportunity for Impact: Raise awareness
Innovators in academic, industry and the nonprofit sector are pushing new approaches to eradicate C.diff.
Opportunity for Impact:
Support & participate in research!