Clostridium difficile colonization in preoperative colorectal cancer patients

// Yi Zheng 1, * , Yun Luo 2, * , Yinxiang Lv 3 , Chen Huang 2 , Qinsong Sheng 4 , Peng Zhao 1 , Julian Ye 2 , Weiqin Jiang 1 , Lulu Liu 1 , Xiaojun Song 2 , Zhou Tong 1 , Wenbin Chen 4 , Jianjiang Lin 4 , Yi-Wei Tang 5 , Dazhi Jin 2 , Weijia Fang 1 1 Cancer Biotherapy Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China 2 Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China 3 Xinchang People’s Hospital, Shaoxing, China 4 Department of Colorectal Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China 5 Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center; Department of Pathology and Medicine, Weill Medical College of Cornell University, New York, NY, USA * These authors have contributed equally to this work Correspondence to: Dazhi Jin, email: dzjin@cdc.zj.cn Weijia Fang, email: weijiafang@zju.edu.cn Keywords: Clostridium difficile , colorectal cancer, colonization, epidemiology, transmission Received: November 02, 2016     Accepted: December 20, 2016     Published: January 02, 2017 ABSTRACT The entire process of Clostridium difficile colonization to infection develops in large intestine. However, the real colonization pattern of C. difficile in preoperative colorectal cancer patients has not been studied. In this study, 33 C. difficile strains (16.1%) were isolated from stool samples of 205 preoperative colorectal cancer patients. C. difficile colonization rates in lymph node metastasis patients (22.3%) were significantly higher than lymph node negative patients (10.8%) (OR=2.314, 95%CI=1.023-5.235, P =0.025). Meanwhile, patients positive for stool occult blood had lower C. difficile colonization rates than negative patients (11.5% vs. 24.0%, OR=0.300, 95%CI=0.131-0.685, P =0.019). A total of 16 sequence types were revealed by multilocus sequence typing. Minimum spanning tree and time-space cluster analysis indicated that all C. difficile isolates were epidemiologically unrelated. Antibiotic susceptibility testing showed all isolates were susceptible to vancomycin and metronidazole. The results suggested that the prevalence of C. difficile colonization is high in preoperative colorectal cancer patients, and the colonization is not acquired in the hospital. Since lymph node metastasis colorectal cancer patients inevitably require adjuvant chemotherapy and C. difficile infection may halt the ongoing treatment, the call for sustained monitoring of C. difficile in those patients is apparently urgent.