Persistent Systemic Microbial Translocation, Inflammation, and Intestinal Damage During Clostridioides difficile...

Area of Science:

• Microbiology
• Gastroenterology
• Infectious Diseases

Background:

• Clostridioides difficile infection (CDI) can lead to serious complications like nosocomial bloodstream infections (n-BSI).
• Gut integrity alterations are hypothesized to play a role in CDI pathogenesis and complications.
• This study investigates markers of gut barrier dysfunction during CDI.

Purpose of the Study:

• To evaluate markers of microbial translocation, inflammation, and intestinal damage in patients with CDI.
• To compare these markers between patients who develop n-BSI and those who do not.
• To assess the impact of fecal microbiota transplantation (FMT) on these markers.

Main Methods:

• Plasma samples were collected from CDI patients before and after therapy (T0 and T1).
• Markers assessed included lipopolysaccharide-binding protein (LPB), EndoCab IgM, interleukin-6, and intestinal fatty acid-binding protein (I-FABP).
• Patients were grouped based on n-BSI development and receipt of FMT; healthy controls were included for comparison.

Main Results:

• 8 out of 45 patients (17.7%) developed n-BSI.
• Markers of microbial translocation and intestinal damage decreased post-therapy but remained higher than in controls.
• Patients who developed n-BSI (BSI+) had persistently higher microbial translocation markers compared to those without (BSI-).
• Fecal microbiota transplantation (FMT+) group showed a trend towards normalized microbial translocation and inflammation markers post-therapy.

Conclusions:

• CDI is associated with significant microbial translocation, inflammation, and intestinal damage that persist even after clinical resolution.
• Residual gut barrier dysfunction may contribute to n-BSI development following CDI.
• Further research is needed to explore the role of mucosal perturbation and the potential of FMT in restoring gut integrity.