van Werkhoven, Cornelis HDucher, AnnieBerkell, MatildaMysara, MohamedLammens, ChristineTorre-Cisneros, JulianRodriguez-Baño, JesusHerghea, DeliaCornely, Oliver ABiehl, Lena MBernard, LouisDominguez-Luzon, M AngelesMaraki, SofiaBarraud, OlivierNica, MariaJazmati, NathalieSablier-Gallis, Frederiquede Gunzburg, JeanMentre, FranceMalhotra-Kumar, SurbhiBonten, Marc J MVehreschild, Maria J G T2023-02-092023-02-092021-03-03van Werkhoven CH, Ducher A, Berkell M, Mysara M, Lammens C, Torre-Cisneros J, et al. Incidence and predictive biomarkers of Clostridioides difficile infection in hospitalized patients receiving broad-spectrum antibiotics. Nat Commun. 2021 Apr 14;12(1):2240http://hdl.handle.net/10668/17578Trial 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.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/AgedAnti-bacterial agentsBiomarkersCarbapenemsCephalosporinsClostridioides difficileClostridium InfectionsDrug therapy, combinationFemaleFluoroquinolonesFollow-up studiesGastrointestinal microbiomeHospitalizationHumansIncidenceMaleMiddle agedPenicillinsProspective studiesResearch article33854064open accessAntibacterianosBiomarcadoresCarbapenémicosFluoroquinolonasHospitalizaciónInfecciones por ClostridiumMicrobioma gastrointestinal10.1038/s41467-021-22269-y2041-1723PMC8046770https://www.nature.com/articles/s41467-021-22269-y.pdfhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046770/pdf