“…These findings are consistent with the recent study of adult SCD patients and are surprising given the many potential risk factors for intestinal dysbiosis in SCD, including frequent antibiotic use, frequent hospitalization, iron overload, hypoxia, and altered gut permeability. 8,12,13 However, the low rates of CDI in both pediatric and adult SCD patients are consistent with the theory that SCD microbiome -likely due to changes in intestinal metabolome is potentially protective against C. difficile disease. 10,14,15 It is hypothesized that hypoxia-reperfusion injury in SCD alters intestinal microbiota and use of opioids impairs intestinal motility, both leading to bacterial overgrowth and subsequently increased concentrations of intestinal butyrate which inhibits the proliferation of C. difficile.…”