Abstract
BackgroundClostridioides difficile infection (CDI) is a leading cause of nosocomial diarrhea. Patients receiving enteral nutrition (EN) in the intensive care unit (ICU) are potentially at high risk of CDI. In the present study, we assessed the risk factors and intestinal microbiome of patients to better understand the occurrence and development of CDI.MethodsPatients were screened for C. difficile every week after starting EN, and their clinical records were collected for risk factor identification. Fecal samples were analyzed using 16S rRNA sequencing to evaluate the intestinal microbiota.ResultsOverall incidence of CDI was 10.7% (18/168 patients). History of cerebral infarction was significantly associated with CDI occurrence (OR, 9.759; 95% CI, 2.140–44.498), and treatment with metronidazole was identified to be protective (OR, 0.287; 95% CI, 0.091–0.902). Patients with EN had lower bacterial richness and diversity, accompanied by a remarkable decrease in the abundance of Bacteroides, Prevotella_9, Ruminococcaceae, and Lachnospiraceae. Of these patients, acquisition of C. difficile resulted in a transient increase in microbial diversity, along with consistent alterations in the proportion of some bacterial taxa, especially Ruminococcaceae and Lachnospiraceae. Upon initiation of EN, patients who were positive for C. difficile later showed an enhanced load of Bacteroides, which was negatively correlated with the abundance of C. difficile when CDI developed.ConclusionICU patients receiving EN have a high prevalence of CDI and a fragile intestinal microbial environment. History of cerebral infarction and prior treatment with metronidazole are considered as vital risk and protective factors, respectively. We propose that the emergence of CDI could cause a protective alteration of the intestinal microbiota. Additionally, Bacteroides loads seem to be closely related to the occurrence and development of CDI.
Highlights
Clostridioides difficile infection (CDI) is a leading cause of nosocomial diarrhea
For C. difficile-negative (CDN) patients, data were collected from time of admission up through 2 weeks postEN, which represented the approximate median number of days passing from start of enteral nutrition (EN) to onset of CDI
We analyzed a total of 695 fecal samples, among which 30 samples from 23 patients revealed positive readings for C. difficile (Table S2)
Summary
Clostridioides difficile infection (CDI) is a leading cause of nosocomial diarrhea. Patients receiving enteral nutrition (EN) in the intensive care unit (ICU) are potentially at high risk of CDI. We assessed the risk factors and intestinal microbiome of patients to better understand the occurrence and development of CDI. In addition to antibiotic usage, risk factors for CDI include advanced age, underlying disease, admission to the intensive care unit (ICU), proton pump inhibitor (PPI) treatment, and enteral nutrition (EN) [5,6,7,8]. EN, known as tube feeding, is widely used among patients admitted to ICUs. Due to the increased access of C. difficile spores through the feeding tube and the usage of prophylactic treatments with antibiotics or PPIs, patients receiving EN are potentially more vulnerable to CDI [9]. The incidence and specific risk factors for CDI in patients with EN have not been comprehensively investigated
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