TY - JOUR
T1 - Incidence and predictive biomarkers of Clostridioides difficile infection in hospitalized patients receiving broad-spectrum antibiotics
AU - van Werkhoven, Cornelis H.
AU - Ducher, Annie
AU - Berkell, Matilda
AU - Ahmed, Mohamed
AU - Lammens, Christine
AU - Torre-Cisneros, Julian
AU - Rodríguez-Baño, Jesús
AU - Herghea, Delia
AU - Cornely, Oliver A.
AU - Biehl, Lena M.
AU - Bernard, Louis
AU - Dominguez-Luzon, M. Angeles
AU - Maraki, Sofia
AU - Barraud, Olivier
AU - Nica, Maria
AU - Jazmati, Nathalie
AU - Sablier-Gallis, Frederique
AU - De Gunzburg, Jean
AU - de Gunzburg, Jean
AU - Malhotra-kumar, Surbhi
AU - Bonten, Marc J.M.
AU - Vehreschild, Maria J.G.T.
N1 - Score=10
PY - 2021/4/14
Y1 - 2021/4/14
N2 - Trial enrichment using gut microbiota derived biomarkers by high-risk individuals can improve the feasibility of randomized controlled trials for prevention of Clostridioides difficile infection (CDI). Here, we report in a prospective observational cohort study the incidence of CDI and assess potential clinical characteristics and biomarkers to predict CDI in 1,007 patients ≥ 50 years receiving newly initiated antibiotic treatment with penicillins plus a betalactamase inhibitor, 3rd/4th generation cephalosporins, carbapenems, fluoroquinolones or clindamycin from 34 European hospitals. The estimated 90-day cumulative incidences of a first CDI episode is 1.9% (95% CI 1.1-3.0). Carbapenem treatment (Hazard Ratio (95% CI): 5.3 (1.7-16.6)), toxigenic C. difficile rectal carriage (10.3 (3.2-33.1)), high intestinal abundance of Enterococcus spp. relative to Ruminococcus spp. (5.4 (2.1-18.7)), and low Shannon alpha diversity index as determined by 16 S rRNA gene profiling (9.7 (3.2-29.7)), but not normalized urinary 3-indoxyl sulfate levels, predicts an increased CDI risk.
AB - Trial enrichment using gut microbiota derived biomarkers by high-risk individuals can improve the feasibility of randomized controlled trials for prevention of Clostridioides difficile infection (CDI). Here, we report in a prospective observational cohort study the incidence of CDI and assess potential clinical characteristics and biomarkers to predict CDI in 1,007 patients ≥ 50 years receiving newly initiated antibiotic treatment with penicillins plus a betalactamase inhibitor, 3rd/4th generation cephalosporins, carbapenems, fluoroquinolones or clindamycin from 34 European hospitals. The estimated 90-day cumulative incidences of a first CDI episode is 1.9% (95% CI 1.1-3.0). Carbapenem treatment (Hazard Ratio (95% CI): 5.3 (1.7-16.6)), toxigenic C. difficile rectal carriage (10.3 (3.2-33.1)), high intestinal abundance of Enterococcus spp. relative to Ruminococcus spp. (5.4 (2.1-18.7)), and low Shannon alpha diversity index as determined by 16 S rRNA gene profiling (9.7 (3.2-29.7)), but not normalized urinary 3-indoxyl sulfate levels, predicts an increased CDI risk.
KW - Microbiota
KW - Biomarkers
KW - Clostridioides difficile infection (CDI)
KW - Antibiotic treatment
UR - https://ecm.sckcen.be/OTCS/llisapi.dll/open/43626370
U2 - 10.1038/s41467-021-22269-y
DO - 10.1038/s41467-021-22269-y
M3 - Article
SN - 2041-1723
VL - 12
SP - 1
EP - 10
JO - Nature Communications
JF - Nature Communications
M1 - 2240
ER -