Dear Colleagues,

The first volume of the Special Issue “Clostridium difficile Infection: Unmet Needs and Unsolved Questions” was published in 2021. It was a successful Special Issue, with 10 published research papers that shed light on several grey areas in our knowledge on Clostridioides difficile infection (CDI) management.

Major issues still affect the management of CDI, including the high rate of CDI underdiagnosis, the unacceptably high rate of CDI recurrence, and the difficulties faced in reducing the spread of CD among hospitalized patients.

The underdiagnosis of CDI is a current issue, either because of suboptimal laboratory diagnostic methods or because of the absence of clinical suspicion. There are unsolved questions, such as why the rate of underdiagnosis differs among countries and among hospitals in the same country, and there is a need to elucidate the reasons for its high rate. In this regard, community-acquired CDI is increasingly represented in the literature, but in “real life” it is poorly studied, and its underdiagnosis has been hypothesized.

No less important is the high recurrence rate observed with the currently available CDI therapy. The alarming rate of CDI recurrence urges the proposal and evaluation of innovative therapeutic approaches.

Undeniably, more efforts are needed in order to reduce the spread of CDI, especially among hospitalized patients. Asymptomatic CD carriers might represent a “submerged iceberg” that significantly contributes to CD hospital spread. Understanding the role that asymptomatic carriers play in perpetuating CD transmission as well as the routes of in-hospital and community CD transmission is crucial but also particularly challenging to examine.

As a continuation of the Special Issue published in 2021, this second part will also deliver a compendium of the latest studies on any aspects concerning CDI management.

Dr. Nicola Petrosillo
Dr. Guido Granata
Guest Editors

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• Clostridioides difficile infection
• infection control
• contact isolation
• community-aquired CDI
• CDI recurrence
• recurrence prevention
• rCDI
• host and microbiota interaction
• antimicrobial treatment
• microbiota transplant
• underdiagnosis