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Bloom and bust: intestinal microbiota dynamics in response to hospital exposures and Clostridium difficile colonization or infection Vincent, Caroline; Miller, Mark A.; Edens, Thaddeus J.; Mehrotra, Sudeep; Dewar, Ken; Manges, Amee R.

Abstract

Background: Clostridium difficile infection (CDI) is the leading infectious cause of nosocomial diarrhea. Hospitalized patients are at increased risk of developing CDI because they are exposed to C. difficile spores through contact with the hospital environment and often receive antibiotics and other medications that can disrupt the integrity of the indigenous intestinal microbiota and impair colonization resistance. Using whole metagenome shotgun sequencing, we examined the diversity and composition of the fecal microbiota in a prospective cohort study of 98 hospitalized patients. Results Four patients had asymptomatic C. difficile colonization, and four patients developed CDI. We observed dramatic shifts in the structure of the gut microbiota during hospitalization. In contrast to CDI cases, asymptomatic patients exhibited elevated relative abundance of potentially protective bacterial taxa in their gut at the onset of C. difficile colonization. Use of laxatives was associated with significant reductions in the relative abundance of Clostridium and Eubacterium; species within these genera have previously been shown to enhance resistance to CDI via the production of secondary bile acids. Cephalosporin and fluoroquinolone exposure decreased the frequency of Clostridiales Family XI Incertae Sedis, a bacterial family that has been previously associated with decreased CDI risk. Conclusions This study underscores the detrimental impact of antibiotics as well as other medications, particularly laxatives, on the intestinal microbiota and suggests that co-colonization with key bacterial taxa may prevent C. difficile overgrowth or the transition from asymptomatic C. difficile colonization to CDI.

Item Metadata

Title
Bloom and bust: intestinal microbiota dynamics in response to hospital exposures and Clostridium difficile colonization or infection
Creator
Vincent, Caroline; Miller, Mark A.; Edens, Thaddeus J.; Mehrotra, Sudeep; Dewar, Ken; Manges, Amee R.
Publisher
BioMed Central
Date Issued
2016-03-14
Description
Background: Clostridium difficile infection (CDI) is the leading infectious cause of nosocomial diarrhea. Hospitalized patients are at increased risk of developing CDI because they are exposed to C. difficile spores through contact with the hospital environment and often receive antibiotics and other medications that can disrupt the integrity of the indigenous intestinal microbiota and impair colonization resistance. Using whole metagenome shotgun sequencing, we examined the diversity and composition of the fecal microbiota in a prospective cohort study of 98 hospitalized patients. Results Four patients had asymptomatic C. difficile colonization, and four patients developed CDI. We observed dramatic shifts in the structure of the gut microbiota during hospitalization. In contrast to CDI cases, asymptomatic patients exhibited elevated relative abundance of potentially protective bacterial taxa in their gut at the onset of C. difficile colonization. Use of laxatives was associated with significant reductions in the relative abundance of Clostridium and Eubacterium; species within these genera have previously been shown to enhance resistance to CDI via the production of secondary bile acids. Cephalosporin and fluoroquinolone exposure decreased the frequency of Clostridiales Family XI Incertae Sedis, a bacterial family that has been previously associated with decreased CDI risk. Conclusions This study underscores the detrimental impact of antibiotics as well as other medications, particularly laxatives, on the intestinal microbiota and suggests that co-colonization with key bacterial taxa may prevent C. difficile overgrowth or the transition from asymptomatic C. difficile colonization to CDI.
Subject
Clostridium difficile infection; Whole metagenome shotgun sequencing; Intestinal microbiota; Antimicrobials; Medications
Genre
Article
Type
Text
Language
eng
Date Available
2016-08-19
Provider
Vancouver : University of British Columbia Library
Rights
Attribution 4.0 International (CC BY 4.0)
DOI
10.14288/1.0308639
URI
http://hdl.handle.net/2429/58868
Affiliation
Medicine, Faculty of; Non UBC; Population and Public Health (SPPH), School of
Citation
Microbiome. 2016 Mar 14;4(1):12
Publisher DOI
10.1186/s40168-016-0156-3
Peer Review Status
Reviewed
Scholarly Level
Faculty
Copyright Holder
Vincent et al.
Rights URI
http://creativecommons.org/licenses/by/4.0/
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Attribution 4.0 International (CC BY 4.0)