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

Cornelis H. Werkhoven (), Annie Ducher, Matilda Berkell, Mohamed Mysara, 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 Gunzburg, France Mentré, Surbhi Malhotra-Kumar, Marc J. M. Bonten and Maria J. G. T. Vehreschild ()
Additional contact information
Cornelis H. Werkhoven: University Medical Center Utrecht, Utrecht University
Annie Ducher: Da Volterra
Matilda Berkell: Vaccine & Infectious Disease Institute, University of Antwerp
Mohamed Mysara: Vaccine & Infectious Disease Institute, University of Antwerp
Christine Lammens: Vaccine & Infectious Disease Institute, University of Antwerp
Julian Torre-Cisneros: Reina Sofia University Hospital, University of Cordoba (UCO)
Jesús Rodríguez-Baño: Hospital Universitario Virgen Macarena
Delia Herghea: Oncology Institute Prof. Dr. I Chiricuta
Oliver A. Cornely: Faculty of Medicine and University Hospital of Cologne, University of Cologne
Lena M. Biehl: Faculty of Medicine and University Hospital of Cologne, University of Cologne
Louis Bernard: Centre hospitalo-universitaire de Tours
M. Angeles Dominguez-Luzon: Universitat de Barcelona
Sofia Maraki: University Hospital of Heraklion
Olivier Barraud: Université Limoges, INSERM U1092, Centre Hospitalier Universitaire de Limoges
Maria Nica: Infectious and Tropical Diseases Hospital “Dr. Victor Babes”
Nathalie Jazmati: Immunology and Hygiene, University of Cologne
Frederique Sablier-Gallis: Da Volterra
Jean Gunzburg: Da Volterra
France Mentré: Université de Paris, INSERM, IAME
Surbhi Malhotra-Kumar: Vaccine & Infectious Disease Institute, University of Antwerp
Marc J. M. Bonten: University Medical Center Utrecht, Utrecht University
Maria J. G. T. Vehreschild: Faculty of Medicine and University Hospital of Cologne, University of Cologne

Nature Communications, 2021, vol. 12, issue 1, 1-10

Abstract: Abstract 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 beta-lactamase 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.

Date: 2021
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DOI: 10.1038/s41467-021-22269-y

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