Immunocompromise Status Does Not Impact Blood, Stool Patterns for CDI Patients

Marcela Banegas, MD

A new analysis shows very little differences in blood samples and stool samples between immunocompromised and non-immunocompromised hosts with clostridiodes difficile infections (CDI).¹

A team, led by Marcela Banegas, Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, evaluated whether the innate immune response to CDI is influenced by an individual’s immunocompromised host status.

CDI is generally influenced by the innate and adaptive immune systems, with previous data showing attenuated humoral responses to C difficile in immunocompromised hosts with CDI.

In the prospective study, the investigators examined hospitalized adults with CDI (acute diarrhea, positive C. difficile stool nucleic acid amplification testing (NAAT), and decision to treat), with and without immunosuppression.

The team measured a panel of different cytokines in blood and stool samples at the time of CDI diagnosis, including G-CSF, IL-10, IL-15, IL-1β, IL-4, IL-6, IL-8, and TNF-α.

The investigators compared the results with the measurements of a cohort of asymptomatic carrier patients who were NAAT positive, without diarrhea. This group included participants who were both with and without immunocompromise.

The study included 123 participants, 42 of which were immunocompromised hosts, 50 were non-immunocompromised hosts, and 31 who were asymptomatic carrier patients.

The median values for blood and stool cytokines were similar in the immunocompromised and non-immunocompromised host population. However, G-CSF, IL-10, IL-15, IL-6 and IL-8 were higher in the blood samples of both groups of patients with CDI compared to the asymptomatic carrier patients (P <0.05).

The stool samples resulted in higher concentrations of IL-1β and IL-8 in both groups of patients with CDI compared to asymptomatic carrier patients (P <0.05).

There were also significant differences in stool concentrations of IL-1β between the groups (median: ICHs 10.97 pg/mL, non-ICH: 9.71 pg/mL and ASC 0.56 pg/mL) (P <0.0001).

“In this small exploratory analysis, ICH status did not significantly impact blood and fecal patterns of cytokines in humans at the diagnosis of CDI, suggesting that the innate immune response to C. difficile may be conserved in immunocompromised patients,” the authors wrote.

Earlier this year, a team of investigators highlighted the need to for better epidemiologic surveillance in order to detect specific clusters of C difficile strains in high risk locations, such as neurosurgery wards.

A team, led by Xiajing Bi, Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, identified the epidemiology of CDII in a neurosurgery department over the course of 24 months, with particular attention paid to the transmission of C difficile using whole-genome sequencing.

There are very few studies focusing on the transmission of C difficile, particularly in wards with low detection rates like neurosurgery departments. However, there is a greater need to identify specific clusters.

The results show isolates from patients in the neurosurgery department basically fell into 2 distinct lineages where s11052403 and s 10090304 were isolated from a patient on the 8th floor and a patient on the 9th floor of the neurosurgery ward.

The 2 strains were highly similar and exhibited differences of only 2 single-nucleotide polymorphisms.

All C difficile ST-37/RT017 strains isolated from neurosurgical patients were resistant to several different classes of antibiotics.

References:

Marcela Banegas, Javier Villafuerte-Gálvez, Rodrigo Paredes, Rebecca Sprague, Caitlin Barrett, Anne J Gonzales-Luna, Kaitlyn Daugherty, Kevin W Garey, Hua Xu, Qianyun Lin, Lamei Wang, Xinhua Chen, Nira R Pollock, Ciarán P Kelly, Carolyn D Alonso, Preservation of the innate immune response to Clostridioides difficile infection in hospitalized immunocompromised patients, Open Forum Infectious Diseases, 2023;, ofad090, https://doi.org/10.1093/ofid/ofad090