Risk factors and intestinal microbiota: Clostridioides difficile infection in patients receiving enteral nutrition at Intensive Care Units

Abstract

Background Clostridioides difficile infection (CDI) is a leading cause of nosocomial diarrhea. Patients receiving enteral nutrition (EN) in the intensive care unit (ICU) are potentially at high risk of CDI. In the present study, we assessed the risk factors and intestinal microbiome of patients to better understand the occurrence and development of CDI. Methods Patients were screened for C. difficile every week after starting EN, and their clinical records were collected for risk factor identification. Fecal samples were analyzed using 16S rRNA sequencing to evaluate the intestinal microbiota. Results Overall incidence of CDI was 10.7% (18/168 patients). History of cerebral infarction was significantly associated with CDI occurrence (OR, 9.759; 95% CI, 2.140–44.498), and treatment with metronidazole was identified to be protective (OR, 0.287; 95% CI, 0.091–0.902). Patients with EN had lower bacterial richness and diversity, accompanied by a remarkable decrease in the abundance of Bacteroides , Prevotella_9 , Ruminococcaceae, and Lachnospiraceae. Of these patients, acquisition of C. difficile resulted in a transient increase in microbial diversity, along with consistent alterations in the proportion of some bacterial taxa, especially Ruminococcaceae and Lachnospiraceae. Upon initiation of EN, patients who were positive for C. difficile later showed an enhanced load of Bacteroides , which was negatively correlated with the abundance of C. difficile when CDI developed. Conclusion ICU patients receiving EN have a high prevalence of CDI and a fragile intestinal microbial environment. History of cerebral infarction and prior treatment with metronidazole are considered as vital risk and protective factors, respectively. We propose that the emergence of CDI could cause a protective alteration of the intestinal microbiota. Additionally, Bacteroides loads seem to be closely related to the occurrence and development of CDI.

Reconsidering ventilator-associated pneumonia from a new dimension of the lung microbiome

“…Lately, recent evidence has supported findings of enteral nutrition being associated with high prevalence of Clostridium difficile Infection [58] .Thus, enteral feeding is associated not solely with a loss in the diversity of the gut microbiome. It is also associated with a loss in unique microbial signatures of different body sites, indicating widespread colonization [59] .…”

In Vitro Fermentation Characteristics and Fiber-Degrading Enzyme Kinetics of Cellulose, Arabinoxylan, β-Glucan and Glucomannan by Pig Fecal Microbiota

“…Positive correlations between lactate and acetate with Provetella_9 were observed in the gut of multiple sclerosis patients [ 43 ]. Provetella_9, as a beneficial bacterium, was present in a low abundance in patients who had Clostridioides difficile infection [ 44 ]. The gut microbiome of multiple sclerosis patients was characterized by a decrease of Prevotella_9 , with glatiramer acetate with acetate as the main ingredient that can prevent and suppress multiple sclerosis, suggesting that acetate may have an important relation with Prevotella_9 [ 43 , 45 ].…”

Diarrhea in tube‐fed hospitalized patients: Feeding formula is not the most common cause

“…Another interesting finding, an underlying of cerebrovascular disease was significantly associated with the development of diarrhea (adjusted OR 10.48, convertible to the risk ration of 2.83). To our knowledge, there were no previous study demonstrated this specific underlying disease as an attributable risk of post‐feeding diarrhea, but recently, Wang et al also reported history of cerebral infarction as a risk of C. difficile infection in critically ill patients receiving EN 27 . The mechanism underlying this association is yet to be defined.…”