%0 Journal Article
%A van Werkhoven, Cornelis H
%A Ducher, Annie
%A Berkell, Matilda
%A Mysara, Mohamed
%A Lammens, Christine
%A Torre-Cisneros, Julian
%A Rodriguez-Baño, Jesus
%A Herghea, Delia
%A Cornely, Oliver A
%A Biehl, Lena M
%A Bernard, Louis
%A Dominguez-Luzon, M Angeles
%A Maraki, Sofia
%A Barraud, Olivier
%A Nica, Maria
%A Jazmati, Nathalie
%A Sablier-Gallis, Frederique
%A de Gunzburg, Jean
%A Mentre, France
%A Malhotra-Kumar, Surbhi
%A Bonten, Marc J M
%A Vehreschild, Maria J G T
%T Incidence and predictive biomarkers of Clostridioides difficile infection in hospitalized patients receiving broad-spectrum antibiotics.
%D 2021
%U http://hdl.handle.net/10668/17578
%X Trial enrichment using gut microbiota derived biomarkers by high-risk individuals can improve the feasibility of randomized controlled trials for prevention of Clostridioides difficile infection (CDI). Here, we report in a prospective observational cohort study the incidence of CDI and assess potential clinical characteristics and biomarkers to predict CDI in 1,007 patients ≥ 50 years receiving newly initiated antibiotic treatment with penicillins plus a beta-lactamase inhibitor, 3rd/4th generation cephalosporins, carbapenems, fluoroquinolones or clindamycin from 34 European hospitals. The estimated 90-day cumulative incidences of a first CDI episode is 1.9% (95% CI 1.1-3.0). Carbapenem treatment (Hazard Ratio (95% CI): 5.3 (1.7-16.6)), toxigenic C. difficile rectal carriage (10.3 (3.2-33.1)), high intestinal abundance of Enterococcus spp. relative to Ruminococcus spp. (5.4 (2.1-18.7)), and low Shannon alpha diversity index as determined by 16 S rRNA gene profiling (9.7 (3.2-29.7)), but not normalized urinary 3-indoxyl sulfate levels, predicts an increased CDI risk.
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