Clostridium difficile colonization in preoperative colorectal cancer patients

Yi Zheng,Weijia Fang,Weiqin Jiang,Peng Zhao,Yun Luo,Lulu Liu,Jianjiang Lin,Zhou Tong,Xiaojun Song,Dazhi Jin,Chen Huang,Yi-Wei Tang,Yinxiang Lv,Qinsong Sheng,Julian Ye,Wenbin Chen

doi:10.18632/oncotarget.14424

Abstract

The entire process of Clostridium difficile colonization to infection develops in large intestine. However, the real colonization pattern of C. difficile in preoperative colorectal cancer patients has not been studied. In this study, 33 C. difficile strains (16.1%) were isolated from stool samples of 205 preoperative colorectal cancer patients. C. difficile colonization rates in lymph node metastasis patients (22.3%) were significantly higher than lymph node negative patients (10.8%) (OR=2.314, 95%CI=1.023-5.235, P =0.025). Meanwhile, patients positive for stool occult blood had lower C. difficile colonization rates than negative patients (11.5% vs. 24.0%, OR=0.300, 95%CI=0.131-0.685, P =0.019). A total of 16 sequence types were revealed by multilocus sequence typing. Minimum spanning tree and time-space cluster analysis indicated that all C. difficile isolates were epidemiologically unrelated. Antibiotic susceptibility testing showed all isolates were susceptible to vancomycin and metronidazole. The results suggested that the prevalence of C. difficile colonization is high in preoperative colorectal cancer patients, and the colonization is not acquired in the hospital. Since lymph node metastasis colorectal cancer patients inevitably require adjuvant chemotherapy and C. difficile infection may halt the ongoing treatment, the call for sustained monitoring of C. difficile in those patients is apparently urgent.

Highlights

Clostridium difficile infection (CDI) is one of the leading causes of antibiotic-associated diarrhea
The results suggested that the prevalence of C. difficile colonization is high in preoperative colorectal cancer patients, and the colonization is not acquired in the hospital
Molecular typing of C. difficile isolates from colorectal cancer (CRC) patients

Summary

Introduction

Clostridium difficile infection (CDI) is one of the leading causes of antibiotic-associated diarrhea. There have been a lot of outbreaks with severe cases reported in the United States and Europe. A recent study indicated that approximately 453,000 cases of CDI and 29,000 deaths associated with CDI were identified each year in the United States [1]. The risk factors of CDI include antibiotic exposure, advanced age and hospitalization, which have been reported in detail and widely accepted [2,3,4,5]. Cancer patients who were immunocompromised were reported to have a higher risk for CDI compared with non-cancer patients. It is due of antibiotic-like activity of several chemotherapy drugs and chemotherapy-induced neutropenia [6, 7]

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