Abstract
Background
A recent study from Taiwan suggested that
Clostridium innocuum may be an unrecognized cause of antibiotic-associated diarrhea (AAD) and clinically indistinguishable from
C. difficile infection. Our objective was to compare
C. innocuum prevalence and strain between those with AAD and asymptomatic controls.
Methods
In this cross-sectional study, we collected stool from 200 individuals with AAD and 100 asymptomatic controls. We evaluated the association between AAD and
C. innocuum in stool using anaerobic culture and qPCR. To identify strain-specific associations with AAD, we performed whole genome sequencing of
C. innocuum isolates using Illumina MiSeq and constructed comparative genomics analyses.
Results
C. innocuum was isolated from stool of 126/300 (42%) subjects and more frequently from asymptomatic controls than AAD subjects (50/100 [50%] vs. 76/200 [38%], respectively; p = 0.047).
C. innocuum isolation frequency was not associated with AAD in either the adult or pediatric subgroups.
C. innocuum and
C. difficile were frequently co-prevalent in individuals with and without diarrhea. There were no phylogenetic differences or accessory genome associations between
C. innocuum isolates from AAD subjects and asymptomatic controls.
Conclusion
C. innocuum was frequently isolated and at a greater frequency in asymptomatic controls than those with AAD. We did not identify strain lineages or accessory genomic elements associated with AAD. These dat a highlight that differentiating
C. innocuum-associated diarrhea from asymptomatic colonization, and differentiating diarrhea caused by
C. difficile from
C. innocuum, are clinical microbiology challenges that require additional investigation to identify host-specific factors and/or biomarkers that distinguish these conditions.
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