A reader is dealing with an antibiotic resistant abscess which have kept recurring after several courses of different antibiotics. She wrote because the latest escalation had a risk of  C. difficile. Actually, it is Peptoclostridium difficile  and not Clostridium difficile, because it has been recently reclassified.

• Peptoclostridium difficile (55.66% of Samples) species
  • Clostridioides difficile NAP07 (0% of Samples) strain
  • Clostridioides difficile NAP08 (0% of Samples) strain
  • Peptoclostridium difficile (strain CD196) (0% of Samples) strain

The first harsh reality is that 55% of people have some of this bacteria…. so the issue is whether this bacteria will seize the opportunity to expand to clinically significant levels.

• “Clostridium difficile is the leading infectious cause of antibiotic-associated diarrhea and colitis. C. difficile infection (CDI) places a heavy burden on the healthcare system, with nearly half a million infections yearly and an approximate 20% recurrence risk after successful initial therapy. ” [2018]
• “Probiotic use did not appear to attenuate the odds of CDI in patients exposed to high-risk antibiotics, but moderate-risk antibiotics appeared to significantly attenuate the odds of CDI in patients who received probiotics.” [2018]
  • “From the perspective of the medical system, oral probiotics as a preventive strategy for CDAD in hospitalized children and adolescents receiving a therapeutic course of antibiotics reduced the risk of CDAD and represents a cost-saving strategy.” [2018]
• ” C. difficile infection incidence in the United States has increased dramatically since 2000. In the United States ” [2018]
  • “Outbreaks of hypervirulent strains of Clostridium difficile began to be reported in healthcare facilities worldwide around 20 years ago. Concurrently, trehalose became a common additive used by the global food industry. A new study provides evidence that these two observations are a linked phenomenon [2018]

Using the http://microbiomeprescription.azurewebsites.net site, we find that the following reduces this bacteria according to studies:

• melatonin supplement
• aspirin (acetylsalicylic acid)
• plantain bananas
• Bismuth Salts
• bile (acid/salts)
• bifidobacterium longum and lactobacillus helveticus (probiotics)
• lactobacillus reuteri (probiotics)
• pyridoxine hydrochloride (vitamin B6)
• thiamine hydrochloride (vitamin B1)
• vitamin b3 (niacin)
• vitamin b7 biotin (supplement) (vitamin B7)

And the following should be avoided:

• glucose (sugar)
• d-trehalose (sugar)

Bottom Line

A sugar-free (or at least reducing sugar content) diet is the first suggestion. Increased vitamin B supplementation and melatonin is also suggested. Adding 1-3 bananas a day may also be beneficial as well as making food from scratch (i.e. no prepared foods due to trehalose additives). Evidence for probiotics is generally deemed weak in all of the latest studies.

NOTES:

• On prepared foods, trehalose may not be explicitly labelled, rather included under “sugar”.
• Trehalose occurs naturally in small amounts in mushrooms, honey, lobsters, shrimps, certain seaweeds (algae), wine, beer, bread and other foods produced by using baker’s or brewer’s yeast ^[3].
• Trehalose is heat stable and preserves the cell structure of foods after heating and freezing, so it is used as a food texturizer and stabilizer in dried foods, frozen foods, nutrition bars, fruit fillings and jams, instant noodles and rice, white chocolate, sugar coating, bakery cream, processed seafood and fruit juices ^[3,4].