Risk factors for nosocomial Clostridioides difficile infection-induced diarrhoea in patients receiving enteral feeding: a scoping review

Nosocomial Clostridioides difficile infection (CDI)-induced diarrhoea is a major healthcare-associated infection, particularly in critically ill patients. Antibiotic use and disruptions in gut microbiota are known risk factors, and the role of enteral feeding (EF) requires further exploration. The aim of this scoping review was to examine risk factors for nosocomial CDI-induced diarrhoea in hospitalized patients receiving enteral feeding and assess the impact of EF-related factors on CDI outcomes. Evidence was synthesized from recent studies evaluating CDI risk in hospitalized patients on EF, focusing on antibiotic exposure, hospitalization duration, EF type, and gut microbiota alterations. Key risk factors identified include prolonged hospitalization, antibiotic use, and feeding tube placement, all of which may facilitate C. difficile colonization. Altered gut microbiota, characterized by reduced bacterial diversity, was associated with prolonged EF and lack of fibre in formulas. Fibre-enriched and polymeric formulas may support microbial balance, while the effects of probiotics on CDI prevention were inconsistent. Management strategies emphasized include antibiotic stewardship, infection control, and optimized nutrition. Faecal microbiota transplantation and bezlotoxumab show promise in reducing recurrence. However, evidence remains limited on whether specific EF modalities (e.g. continuous vs intermittent feeding, polymeric vs elemental formulas) directly affect CDI risk. EF may contribute to CDI risk through its impact on gut microbiota and related factors. While certain EF strategies show potential benefits, further research is needed to determine their role in CDI prevention and to develop evidence-based nutritional guidelines for at-risk patients.