The Intersection Between Colonization Resistance, Antimicrobial Stewardship, and Clostridium difficile

  • Rossana RosaEmail author
  • Curtis J. Donskey
  • L. Silvia Munoz-Price
Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Healthcare Associated Infections


Purpose of Review

Colonization resistance refers to the innate defense provided by the indigenous microbiota against colonization by pathogenic organisms. We aim to describe how this line of defense is deployed against Clostridium difficile and what the implications are for interventions directed by Antimicrobial Stewardship Programs.

Recent Findings

The indigenous microbiota provides colonization resistance through depletion of nutrients, prevention of access to adherence sites within the gut mucosa, production of inhibitory substances, and stimulation of the host’s immune system. The ability to quantify colonization resistance could provide information regarding periods of maximal vulnerability to colonization with pathogens and also allow the identification of mechanisms of restoration of colonization resistance. Methods utilized to determine the composition of the gut microbiota include sequencing technologies and measurement of concentration of specific bacterial metabolites.


Use of innovations in the quantification of colonization resistance can expand the role of Antimicrobial Stewardship from prevention of disruption of the indigenous microbiota to restoration of colonization resistance.


Colonization resistance Clostridium difficile Antimicrobial stewardship 


Compliance with Ethical Standards

Conflict of Interest

Curtis J. Donskey has received grants from Pfizer, Merck, Gojo Industries, Clorox, and Ecolab and is on the advisory board of Synthetic biologics.

Silvia Munoz-Price and Rossana Rosa declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human subjects performed by any of the authors.

All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Rossana Rosa
    • 1
    Email author
  • Curtis J. Donskey
    • 2
  • L. Silvia Munoz-Price
    • 3
  1. 1.UnityPoint HealthDes MoinesUSA
  2. 2.Geriatric Research, Education and Clinical CenterCleveland Veterans Affairs Medical CenterClevelandUSA
  3. 3.Division of Infectious Diseases, Department of MedicineMedical College of WisconsinMilwaukeeUSA

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