title: Impacts of infection with different toxigenic Clostridium difficile strains on faecal microbiota in children.
abstract: Increasing evidence suggests that altered intestinal microbial composition and function result in an increased risk of Clostridium difficile-associated diarrhoea (CDAD); however, the specific changes of intestinal microbiota in children suffering from CDAD and their associations with C. difficile strain toxigenicity are poorly understood. High-throughput pyrosequencing showed that reduced faecal bacterial diversity and dramatic shifts of microbial composition were found in children with CDAD. The Firmicutes/Bacteroidetes ratio was increased significantly in patients with CDAD, which indicated that dysbiosis of faecal microbiota was closely associated with CDAD. C. difficile infection resulted in an increase in lactate-producing phylotypes, with a corresponding decrease in butyrate-producing bacteria. The decrease in butyrate and lactate buildup impaired intestinal colonisation resistance, which increased the susceptibility to C. difficile colonisation. Strains of C. difficile which were positive for both toxin A and toxin B reduced faecal bacterial diversity to a greater degree than strains that were only toxin B-positive, and were associated with unusually abundant Enterococcus, which implies that the C. difficile toxins have different impacts on the faecal microbiota of children. Greater understanding of the relationships between disruption of the normal faecal microbiota and colonisation with C. difficile that produces different toxins might lead to improved treatment.
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
authors.forename: Zongxin
authors.initials: Z
authors.lastname: Ling
authors.affiliation: 1] Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China [2] Intensive Care Unit, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, Affiliated Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
authors.forename: Xiaoyun
authors.initials: X
authors.lastname: Jia
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
authors.forename: Yiwen
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
authors.forename: Yueqiu
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
authors.forename: Li
authors.initials: L
authors.lastname: Yuan
authors.affiliation: Shanghai-MOST Key Laboratory of Health and Disease Genomics, Chinese National Human Genome Center at Shanghai, Shanghai 201203, China.
authors.forename: Yuezhu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, Affiliated Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
authors.forename: Chunna
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Department of Gastroenterology, Affiliated Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
authors.forename: Shu
authors.initials: S
authors.lastname: Guo
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
authors.forename: Lanjuan
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, Affiliated Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
authors.forename: Xiwei
authors.initials: X
authors.lastname: Xu
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, China.
authors.forename: Charlie
authors.initials: C
authors.lastname: Xiang
mesh_terms: D001427:Bacterial Toxins / Q000302:isolation & purification*; D016022:Case-Control Studies; D002675:Child, Preschool; D016360:Clostridioides difficile; D003967:Diarrhea / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000503:physiopathology / Q000635:transmission*; D005243:Feces / Q000382:microbiology*; D006801:Humans; D007422:Intestines / Q000382:microbiology*; D064307:Microbiota; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D060888:Real-Time Polymerase Chain Reaction; D017422:Sequence Analysis, DNA
chemical_list: D001427:Bacterial Toxins; D012336:RNA, Ribosomal, 16S