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Antibiotic-Associated Diarrhea Beyond C. Difficile: A Scoping Review

Vijairam Selvaraj1, Mohd Amer Alsamman2

  • 1Department of Medicine The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA.

The Brown Journal of Hospital Medicine
|March 6, 2025
PubMed

Insights

Antibiotic-associated diarrhea (AAD) stems from gut microbiota disruption. This review clarifies the roles of *Clostridioides difficile* and other microbes in AAD pathogenesis.

Area of Science:

  • Gastroenterology
  • Microbiology
  • Pharmacology

Background:

  • Antibiotic use frequently leads to diarrheal illness.
  • Antibiotic-associated diarrhea (AAD) pathogenesis involves gut microbiota alteration, pathogen overgrowth, and drug toxicity.
  • Less than 33% of AAD cases are linked to *Clostridioides difficile* (CDI), indicating other causes remain poorly understood.

Purpose of the Study:

  • To systematically review existing data on AAD.
  • To elucidate the pathogenic mechanisms of both CDI and non-CDI AAD.
  • To provide a comprehensive understanding of AAD etiology.

Main Methods:

  • Systematic review of current literature on AAD.
  • Analysis of data on microbial alterations and opportunistic pathogen proliferation.
  • Inclusion of figures detailing pathogenic mechanisms.

Main Results:

  • Established pathogenesis of *Clostridioides difficile* infection (CDI).
  • Identified unclear roles and mechanisms for other putative microbial causes of AAD, including *Clostridium perfringens*, *Staphylococcus aureus*, *Klebsiella oxytoca*, and *Candida species*.
  • Highlighted significant gaps in diagnosing and treating non-CDI AAD.

Conclusions:

  • AAD is a complex condition with multiple potential microbial triggers beyond *C. difficile*.
  • Further research is needed to clarify the pathogenesis of non-CDI AAD.
  • Improved diagnostic and therapeutic strategies are required for the majority of AAD cases.
Keywords:
AADAntibiotic associated diarrheaCdifficileCdifficile infectionDiarrheaclostridium difficilestaphylococcus aureus

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