TOPLINE:

The presence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in the intestinal tract was independently associated with higher odds of developing Clostridioides difficile infection.

METHODOLOGY:

• This retrospective cohort study examined whether intestinal colonisation with multidrug-resistant bacteria was associated with the occurrence of C difficile infection.
• The analysis included 192 patients tested for C difficile (mean age, 66.78 years; 56.3% women); of these, 100 had diarrhoea and tested positive for antigen and toxin using enzyme immunoassay and 92 served as control patients who had diarrhoea and tested negative for both tests.
• Fresh stool samples were screened for multidrug-resistant bacteria, including ESBL-producing bacteria, vancomycin-resistant enterococci, and carbapenemase-producing bacteria.

TAKEAWAY:

• Colonisation with ESBL-producing bacteria was an independent predictor of C difficile infection in the adjusted analysis (odds ratio [OR], 2.86; P = .002); prior antibiotic exposure was also independently associated with C difficile infection (OR, 2.67; P = .008).
• Vancomycin-resistant enterococci were not independently associated with C difficile infection.
• Compared with control patients, those with C difficile infection had higher rates of recent antibiotic use (54.3% vs 83.0%), higher rates of colonisation with ESBL-producing bacteria (23.9% vs 52.0%), and more frequent vancomycin-resistant enterococci detection (4.3% vs 14.0%).
• No carbapenemase-producing organisms were detected.

IN PRACTICE:

"This [study] finding may have implications for antibiotic selection, particularly in older patients, and for preventive strategies aimed at limiting nosocomial MDR [multidrug-resistant] spread," the authors wrote.

SOURCE:

This study was led by Marek Duricek, Charles University and University Hospital Bulovka, Prague, Czech Republic. It was published online on May 01, 2026, in the International Journal of Infectious Diseases.

LIMITATIONS:

This study was limited by the single-centre design, residual confounding, and retrospective nature. Surveillance for multidrug-resistant organisms was stopped at the time of C difficile infection diagnosis, limiting the assessment of how long the elevated risk for colonisation persists after infection.

DISCLOSURES:

This study was conducted as part of routine work without external funding, and the authors reported having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.