Abstract
Clostridioides difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea, especially in hospitalized elderly patients, representing a global public health concern. Clinical presentations vary from mild diarrhea to severe pseudomembranous colitis that may progress to toxic megacolon or intestinal perforation. Antibiotic therapy is recognized as a risk factor and exacerbates dysbiosis of the intestinal microbiota, whose role in CDI is increasingly acknowledged. A clinically challenging complication is the development of recurrent disease (rCDI). In this study, using amplicon metagenomics, we compared the fecal microbiota of CDI and rCDI patients (sampled at initial and recurrent episode) and of non-infected controls. We also investigated whether CDI severity relates to specific microbiota compositions. rCDI patients showed a significantly decreased bacterial diversity as compared to controls (p < 0.01). The taxonomic composition presented significant shifts: both CDI and rCDI patients displayed significantly increased frequencies of Firmicutes, Peptostreptococcaceae, Clostridium XI, Clostridium XVIII, and Enterococcaceae. Porphyromonadaceae and, within it, Parabacteroides displayed opposite behaviors in CDI and rCDI, appearing discriminant between the two. Finally, the second episode of rCDI was characterized by significant shifts of unclassified Clostridiales, Escherichia/Shigella and Veillonella. No peculiar taxa composition correlated with the severity of infection, likely reflecting the role of host-related factors in determining severity.
Highlights
Clostridioides difficile infection (CDI) is the leading cause of infectious diarrhea, especially in hospitalized patients and in the community setting, representing a significant health problem worldwide.CDI is associated with a wide range of clinical features, from asymptomatic colonization to mildBiomedicines 2020, 8, 335; doi:10.3390/biomedicines8090335 www.mdpi.com/journal/biomedicinesBiomedicines 2020, 8, 335 diarrhea and to the more severe pseudomembranous colitis that may progress to toxic megacolon, intestinal perforation, sepsis, and death [1]
The infection with C. difficile is accompanied by an expansion of Enterococcaceae (17% vs. 8.7% in C, 12.2% and 5.3% respectively in rCDI1 and rCDI2) and Porphyromonadaceae, (8.7% vs. 3.7% in C, and values < 1% in both rCDI1 and rCDI2)
CDI has known dramatic increases in severity and incidence considered the major cause of antibiotic-associated diarrhea, especially in healthcare settings and in over the past decade, with frequent outbreaks, especially in hospitals, reported both in Europe elderly individuals over the age of 65
Summary
Clostridioides difficile infection (CDI) is the leading cause of infectious diarrhea, especially in hospitalized patients and in the community setting, representing a significant health problem worldwide.CDI is associated with a wide range of clinical features, from asymptomatic colonization to mildBiomedicines 2020, 8, 335; doi:10.3390/biomedicines8090335 www.mdpi.com/journal/biomedicinesBiomedicines 2020, 8, 335 diarrhea and to the more severe pseudomembranous colitis that may progress to toxic megacolon, intestinal perforation, sepsis, and death [1]. Clostridioides difficile infection (CDI) is the leading cause of infectious diarrhea, especially in hospitalized patients and in the community setting, representing a significant health problem worldwide. CDI is associated with a wide range of clinical features, from asymptomatic colonization to mild. Most hospitalized patients infected by C. difficile are asymptomatic carriers, this population serves as a reservoir for continued C. difficile contamination of the hospital environment [2]. The contact with spore-contaminated surfaces is one route by which this pathogen spreads to new hosts. C. difficile spores are transformed into an active state within the gastrointestinal tract once ingested [3]. C. difficile releases the toxins that damage the enteric mucosal lining, by inducing apoptosis and necrosis of epithelial cells, contributing substantially to the inflammatory picture [4]
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