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Oral 4 Gut Microbiota Changes as Predictors of Treatment Failure in Primary Clostridium Difficile Infection
Author Insight from Sahil Khanna, MBBS, MS, Mayo Clinic, Rochester, MN
What’s new here and important for clinicians?
C. difficile infection patients are at a high risk for complications such as treatment failure (5-15%) and recurrent infection (20% after first infection). Gut microbiota signatures associated with CDI have been described, but it is unclear if differences in gut microbiota play a role in response to therapy. No studies have identified predictors of treatment failure, and we aimed to identify gut microbiota signatures to predict response to treatment for primary CDI. While there were no clinical predictors of treatment response, there were increases in certain genera in patients with successful treatment response in the fecal samples at initial diagnosis compared to non-responders. A risk index built from this panel of microbes highly differentiated between patients based on response and ROC curve analysis showed that this risk index was a strong predictor of treatment response, with an area under the curve of 0.85. Gut microbiota signatures can be used to predict response to initial treatment, potentially allowing patients likely to fail treatment to be treated earlier, with more effective therapies such as fecal microbiota transplantation.
What do patients need to know?
C. difficile-infected patients are at a high risk of complications such as treatment failure (5-15%) and recurrent infection (20% after first infection). Clinical predictors of treatment failure in C. difficile are not known, but there are differences in composition of the gut bacteria in the stool that may predict treatment response. These findings suggest that there may be a role for the performance of microbiome analyses in the stool samples at C. difficile diagnosis to predict successful treatment response.
Sahil Khanna, MBBS, MS, Mayo Clinic, Rochester, MN
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