Temporal Gut Microbial Changes Predict Recurrent Clostridiodes Difficile Infection in Patients With and Without...

Area of Science:

• Microbiome research
• Gastroenterology
• Infectious disease

Background:

• Ulcerative colitis (UC) patients have a higher risk of Clostridiodes difficile infection (CDI), which can trigger UC flares.
• Specific alterations in fecal microbial composition are hypothesized to be linked to UC flare and recurrent CDI (rCDI).

Purpose of the Study:

• To investigate the association between fecal microbial profiles and the risk of rCDI and UC flare in patients with UC.
• To identify microbial biomarkers that can predict these adverse outcomes.

Main Methods:

• A prospective observational cohort study involving 57 patients with UC and/or CDI.
• 16S rRNA sequencing of stool samples collected at multiple time points (baseline, post-antibiotics, post-reconstitution).
• Logistic regression and Lasso models were used to analyze microbial data and predict outcomes.

Main Results:

• Patients with rCDI showed significant differences in gut microbial community structure compared to non-rCDI patients.
• Predictive models incorporating baseline and post-treatment microbial features, alongside clinical factors like female gender and UC hospitalization, accurately predicted rCDI risk (AuROC up to 0.94).
• A baseline model including UC hospitalization and increased Bacteroidetes predicted UC flare risk (AuROC 0.88).

Conclusions:

• Fecal microbial features before and after therapy are valuable predictors of rCDI risk in patients with and without UC.
• These microbial insights can aid in stratifying patients based on their risk for rCDI and UC flare, informing clinical management decisions.