Frontiers in Cellular and Infection Microbiology (Sep 2023)

Microbiome profile and calprotectin levels as markers of risk of recurrent Clostridioides difficile infection

  • Silvia Vázquez-Cuesta,
  • Silvia Vázquez-Cuesta,
  • Silvia Vázquez-Cuesta,
  • Nuria Lozano García,
  • Nuria Lozano García,
  • Ana I. Fernández,
  • Ana I. Fernández,
  • María Olmedo,
  • María Olmedo,
  • Martha Kestler,
  • Martha Kestler,
  • Martha Kestler,
  • Luis Alcalá,
  • Luis Alcalá,
  • Luis Alcalá,
  • Mercedes Marín,
  • Mercedes Marín,
  • Mercedes Marín,
  • Mercedes Marín,
  • Javier Bermejo,
  • Javier Bermejo,
  • Javier Bermejo,
  • Javier Bermejo,
  • Francisco Fernández-Avilés Díaz,
  • Francisco Fernández-Avilés Díaz,
  • Francisco Fernández-Avilés Díaz,
  • Francisco Fernández-Avilés Díaz,
  • Patricia Muñoz,
  • Patricia Muñoz,
  • Patricia Muñoz,
  • Patricia Muñoz,
  • Emilio Bouza,
  • Emilio Bouza,
  • Emilio Bouza,
  • Emilio Bouza,
  • Elena Reigadas,
  • Elena Reigadas,
  • Elena Reigadas

DOI
https://doi.org/10.3389/fcimb.2023.1237500
Journal volume & issue
Vol. 13

Abstract

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IntroductionClostridioides difficile infection (CDI) is the main cause of nosocomial diarrhoea in developed countries. Recurrent CDI (R-CDI), which affects 20%-30% of patients and significantly increases hospital stay and associated costs, is a key challenge. The main objective of this study was to explore the role of the microbiome and calprotectin levels as predictive biomarkers of R-CDI.MethodsWe prospectively (2019-2021) included patients with a primary episode of CDI. Clinical data and faecal samples were collected. The microbiome was analysed by sequencing the hypervariable V4 region of the 16S rRNA gene on an Illumina Miseq platform.ResultsWe enrolled 200 patients with primary CDI, of whom 54 developed R-CDI and 146 did not. We analysed 200 primary samples and found that Fusobacterium increased in abundance, while Collinsella, Senegalimassilia, Prevotella and Ruminococcus decreased in patients with recurrent versus non-recurrent disease. Elevated calprotectin levels correlated significantly with R-CDI (p=0.01). We built a risk index for R-CDI, including as prognostic factors age, sex, immunosuppression, toxin B amplification cycle, creatinine levels and faecal calprotectin levels (overall accuracy of 79%).DiscussionCalprotectin levels and abundance of microbial genera such as Fusobacterium and Prevotella in primary episodes could be useful as early markers of R-CDI. We propose a readily available model for prediction of R-CDI that can be applied at the initial CDI episode. The use of this tool could help to better tailor treatments according to the risk of R-CDI.

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