title: Longitudinal survey of Clostridium difficile presence and gut microbiota composition in a Belgian nursing home.
abstract: BACKGROUND
  Increasing age, several co-morbidities, environmental contamination, antibiotic exposure and other intestinal perturbations appear to be the greatest risk factors for C. difficile infection (CDI). Therefore, elderly care home residents are considered particularly vulnerable to the infection. The main objective of this study was to evaluate and follow the prevalence of C. difficile in 23 elderly care home residents weekly during a 4-month period. A C. difficile microbiological detection scheme was performed along with an overall microbial biodiversity study of the faeces content by 16S rRNA gene analysis.
  
  
  RESULTS
  Seven out of 23 (30.4 %) residents were (at least one week) positive for C. difficile. C. difficile was detected in 14 out of 30 diarrhoeal samples (43.7 %). The most common PCR-ribotype identified was 027. MLVA showed that there was a clonal dissemination of C. difficile strains within the nursing home residents. 16S-profiling analyses revealed that each resident has his own bacterial imprint, which was stable during the entire study. Significant changes were observed in C. difficile positive individuals in the relative abundance of a few bacterial populations, including Lachnospiraceae and Verrucomicrobiaceae. A decrease of Akkermansia in positive subjects to the bacterium was repeatedly found.
  
  
  CONCLUSIONS
  A high C. difficile colonisation in nursing home residents was found, with a predominance of the hypervirulent PCR-ribotype 027. Positive C. difficile status is not associated with microbiota richness or biodiversity reduction in this study. The link between Akkermansia, gut inflammation and C. difficile colonisation merits further investigations.
authors.affiliation: Food Science Department, FARAH, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium. c.rodriguez@ulg.ac.be.
authors.forename: Cristina
authors.initials: C
authors.lastname: Rodriguez
authors.affiliation: Food Science Department, FARAH, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.
authors.forename: Bernard
authors.initials: B
authors.lastname: Taminiau
authors.affiliation: Food Science Department, FARAH, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Korsak
authors.affiliation: National Reference Laboratory for Clostridium difficile, Cliniques Universitaires Saint Luc, Microbiology Unit, Catholic University of Louvain, Brussels, Belgium.
authors.forename: Véronique
authors.initials: V
authors.lastname: Avesani
authors.affiliation: National Reference Laboratory for Clostridium difficile, Cliniques Universitaires Saint Luc, Microbiology Unit, Catholic University of Louvain, Brussels, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Van Broeck
authors.affiliation: Nursing Home Saint-Joséphine site de la Chaussée, ACIS, Theux, Belgium.
authors.forename: Philippe
authors.initials: P
authors.lastname: Brach
authors.affiliation: National Reference Laboratory for Clostridium difficile, Cliniques Universitaires Saint Luc, Microbiology Unit, Catholic University of Louvain, Brussels, Belgium.
authors.forename: Michel
authors.initials: M
authors.lastname: Delmée
authors.affiliation: Food Science Department, FARAH, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium.
authors.forename: Georges
authors.initials: G
authors.lastname: Daube
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology; D016360:Clostridioides difficile / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D003967:Diarrhea / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D000069196:Gastrointestinal Microbiome; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: 16S rRNA gene analysis; C. difficile; Elderly care home residents