title: Gut microbiome predictors of treatment response and recurrence in primary Clostridium difficile infection.
abstract: Clostridium difficile infection (CDI) may not respond to initial therapy and frequently recurs, but predictors of response and recurrence are inconsistent. The impact of specific alterations in the gut microbiota determining treatment response and recurrence in patients with CDI is unknown.
  
  
  
  To assess microbial signatures as predictors of treatment response and recurrence in CDI.
  
  
  
  Pre-treatment stool samples and clinical metadata including outcomes were collected prospectively from patients with their first CDI episode. Next generation 16s rRNA sequencing using MiSeq Illumina platform was performed and changes in microbial community structure were correlated with CDI outcomes.
  
  
  
  Eighty-eight patients (median age 52.7 years, 60.2% female) were included. Treatment failure occurred in 12.5% and recurrence after response in 28.5%. Patients who responded to treatment had an increase in Ruminococcaceae, Rikenellaceae, Clostridiaceae, Bacteroides, Faecalibacterium and Rothia compared to nonresponders. A risk-index built from this panel of microbes differentiated responders (mean 0.07 ± 0.24) from nonresponders (0.52 ± 0.42; P = 0.0002). Receiver operating characteristic (ROC) curve demonstrated that risk-index was a strong predictor of treatment response with an area under the curve (AUC) of 0.85. Among clinical parameters tested, only proton pump inhibitor use predicted recurrent CDI (OR 3.75, 95% CI 1.27-11.1, P = 0.01). Patients with recurrent CDI had statistically significant increases in Veillonella, Enterobacteriaceae, Streptococci, Parabacteroides and Lachnospiraceae compared to patients without recurrence and a risk index was able to predict recurrence (AUC = 0.78).
  
  
  
  Gut microbiota signatures predict treatment response and recurrence potentially, allowing identification of patients with Clostridium difficile infection that may benefit from early institution of alternate therapies.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Sahil
authors.initials: S
authors.lastname: Khanna
authors.affiliation: EA 3826 Thérapeutiques Cliniques et Expérimentales des Infections, Faculté de Médecine, Université de Nantes, Nantes, France.|Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Montassier
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Bradley
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, Rochester, MN.|Division of Clinical Microbiology, Department of Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Robin
authors.initials: R
authors.lastname: Patel
authors.affiliation: Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN.
authors.forename: Daniel
authors.initials: D
authors.lastname: Knights
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Purna
authors.initials: P
authors.lastname: Kashyap
mesh_terms: D000328:Adult; D000368:Aged; D016360:Clostridioides difficile / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000382:microbiology*; D005260:Female; D000069196:Gastrointestinal Microbiome; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D012008:Recurrence; D017211:Treatment Failure
chemical_list: D054328:Proton Pump Inhibitors; D012336:RNA, Ribosomal, 16S