{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T08:21:06Z","timestamp":1788337266786,"version":"build-2803163510"},"reference-count":119,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Clostridioides difficile infection (CDI) remains a major cause of antibiotic-associated diarrhea, with recurrence largely driven by disruption of the gut microbiota and impaired colonization resistance. Bile acids have emerged as key mediators in this process, as primary conjugated bile acids promote C. difficile spore germination, whereas microbiota-derived secondary bile acids can inhibit germination, vegetative growth, and toxin activity. Diet further modulates CDI susceptibility by shaping microbial composition, short-chain fatty acid production, bile acid transformation, epithelial barrier integrity, and intestinal inflammation. Western-style diets, and low fiber intake, may favor dysbiosis and a bile acid profile permissive to CDI, while fiber-rich and Mediterranean-type dietary patterns may support beneficial anaerobes, microbial metabolites, and mucosal resilience. This narrative review summarizes current evidence on the bile acid\u2013diet\u2013microbiome axis in CDI pathogenesis, recurrence, and therapy. It also discusses standard treatment limitations, microbiome-based therapeutics, dietary interventions, and emerging bile acid-targeted strategies. Understanding this axis may support future precision approaches aimed not only at suppressing C. difficile, but also at restoring microbiota function and durable colonization resistance.<\/jats:p>","DOI":"10.3390\/nu18172872","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T07:53:11Z","timestamp":1788335591000},"page":"2872","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Bile Acid\u2013Diet\u2013Microbiome Axis in Clostridioides difficile Infection"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8551-3053","authenticated-orcid":false,"given":"Felicia","family":"Trofin","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Sf. Spiridon County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0126-0640","authenticated-orcid":false,"given":"Elena Roxana","family":"Buzila","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Iasi Regional Center for Public Health, National Institute of Public Health, 700465 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina Roxana","family":"Iancu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Sf. Spiridon County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Gabriela","family":"Tuchilus","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Sf. Spiridon County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2791-5165","authenticated-orcid":false,"given":"Oana-Raluca","family":"Temneanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Sf. Maria Children Emergency Hospital, 700309 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2592-3982","authenticated-orcid":false,"given":"Luminita Smaranda","family":"Iancu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Iasi Regional Center for Public Health, National Institute of Public Health, 700465 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7248-4388","authenticated-orcid":false,"given":"Madalina Alexandra","family":"Vlad","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Sf. Spiridon County Clinical Emergency Hospital Iasi, 700111 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8657-378X","authenticated-orcid":false,"given":"Dana-Teodora","family":"Anton-P\u0103duraru","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Sf. Maria Children Emergency Hospital, 700309 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6082-4798","authenticated-orcid":false,"given":"Ioana","family":"Armasu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida Corina","family":"Badescu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania"},{"name":"Sf. 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Parascheva Clinical Hospital of Infectious Diseases, 700116 Iasi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1056\/NEJM197803092981003","article-title":"Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia","volume":"298","author":"Bartlett","year":"1978","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1086\/521863","article-title":"Clinical recognition and diagnosis of Clostridium difficile infection","volume":"46","author":"Bartlett","year":"2008","journal-title":"Clin. Infect. 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