Incidence and predictive biomarkers of Clostridioides difficile infection in hospitalized patients receiving broad-spectrum antibiotics

Cornelis H. van Werkhoven, Annie Ducher, Matilda Berkell, Mohamed Ahmed, Christine Lammens, Julian Torre-Cisneros, Jesús Rodríguez-Baño, Delia Herghea, Oliver A. Cornely, Lena M. Biehl, Louis Bernard, M. Angeles Dominguez-Luzon, Sofia Maraki, Olivier Barraud, Maria Nica, Nathalie Jazmati, Frederique Sablier-Gallis, Jean De Gunzburg, Jean de Gunzburg, Surbhi Malhotra-kumarMarc J.M. Bonten, Maria J.G.T. Vehreschild

    Research outputpeer-review


    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.
    Original languageEnglish
    Article number2240
    Pages (from-to)1-10
    Number of pages10
    JournalNature Communications
    StatePublished - 14 Apr 2021

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