Investigation of Intestinal Microbiota and Fecal Calprotectin in Non-Toxigenic and Toxigenic Clostridioides difficile Colonization and Infection

Abstract

In this study, we aimed to evaluate the composition of the intestinal microbiota and level of fecal calprotectin in Clostridioides difficile-colonized patients. We included 102 C. difficile non-colonized (group I), 93 C. difficile colonized subjects (group II), and 89 diarrhea patients with C. difficile (group III). Chao1 index for alpha diversity and principal coordinate analysis was performed for beta diversity using QIIME. The mean relative abundance in each group was compared at the phylum and genus levels. Fecal calprotectin was measured using EliA calprotectin (Thermo Fisher Scientific). Group II showed significantly lower levels of Sutterella, Blautia, Ruminococcus, Faecalibacterium, Bilophila, and Ruminococcaceae and higher levels of Enterobacteriaceae compared to group I (p = 0.012, 0.003, 0.002, 0.001, 0.027, 0.022, and 0.036, respectively). Toxigenic C. difficile colonized subjects showed significantly lower levels of Prevotella, Phascolarctobacterium, Succinivibrio, Blautia, and higher levels of Bacteroides. The level of fecal calprotectin in group III was significantly higher than those in group I and group II (p < 0.001 for both). These data could be valuable in understanding C. difficile colonization process and the microbiota and inflammatory markers could be further studied to differentiate colonization from CDI.

Gut Dysbiosis and Clostridioides difficile Infection in Neonates and Adults

“…These gut microbiota changes in symptomatic patients were accompanied by significantly higher levels of fecal calprotectin, comparatively with asymptomatic patients and controls. These data suggest that association of microbiota and inflammatory markers could be used to differentiate C. difficile colonization (CDC) from CDI ( Han et al, 2020 ).…”

Gut Microbiota Diversity of Preterm Neonates Is Associated With Clostridioides Difficile Colonization

“…Alpha diversity at D7 (EPIFLORE_D7_2 dataset) was also higher when C. difficile was detected in samples from the same PN at D28. These findings are unusual compared to available data from 16S rRNA gene NGS analysis suggesting that C. difficile colonization is associated with a decreased alpha diversity of the gut microbiota in adults and children (Chen et al, 2019;Han et al, 2019;Crobach et al, 2020;Han et al, 2020). In a study performed in two Dutch NICUs, Crobach et al reported that the Shannon index was significantly higher in 43 control adult individuals than in 41 C. difficile-colonized or 41 -infected patients (p < 0.01), whereas no difference was seen between colonized and infected patients (Crobach et al, 2020).…”

“…In a pediatric population (median age 14 years, range 4–19 years, n=113), alpha diversity was also significantly lower in the C. difficile -colonized group ( p = 0.029) ( Chen et al., 2019 ). However, another study showed no difference in alpha diversity (Chao1 index) between C. difficile -colonized (n=93) and control (n=93) adults ( p = 0.797) ( Han et al., 2020 ). Unlike older populations, our results suggest that in PN, C. difficile colonization is concomitant with physiological establishment and diversification of the gut microbiota.…”

“…Using LefSe analysis, we identified several bacterial biomarkers associated with C. difficile colonization of PN, including Veillonella , Lachnospiraceae, Oscillospiraceae, and Enterobacteriaceae. Veillonella are commensal bacteria of the oral cavity that have been previously associated with CDI ( Han et al., 2020 ). Veillonella is associated with low rates of coprostanol, a cholesterol metabolite.…”

“…The link between intestinal dysbiosis and C. difficile infection (CDI) or colonization is gaining interest ( Chen et al., 2019 ; Crobach et al., 2020 ; Han et al., 2020 ). C. difficile establishment in the adult gut occurs during dysbiosis, and CDI is associated with gut microbiota disruption leading to an increased risk of relapse ( Barbut and Couturier, 2019 ).…”