Gut microbiota composition related with <i>Clostridium difficile</i>-positive diarrhea and <i>C. difficile</i> type (A⁺B⁺, A^-B⁺, and A^-B^-) in ICU hospitalized patients

AbstractBackgroundGut microbiota composition of intensive care unit (ICU) patients suffering from Clostridium difficile-positive diarrhea (CDpD) is still poorly understood. This study aims to use 16S rDNA (and metagenome) sequencing to compare the microbiota composition of 58 (and 5) ICU patients with CDpD (CDpD group), 33 (and 4) ICU patients with C. difficile negative diarrhea (CDnD group), and 21 (and 5) healthy control subjects (control group), as well as CDpD patients in A+B+ (N=34; A/B: C. difficile TcdA/B), A-B+ (N=7), and A-B- (N=17) subgroups. For 16S rDNA data, OTU clustering (tool: UPARSE), taxonomic assignment (tool: RDP classifier), α-diversity and β-diversity analyses (tool: QIIME) were conducted. For metagenome data, metagenome assembly (tool: SOAP), gene calling (tools: MetaGeneMark, CD-HIT, and SoapAligner), unigene alignment (tool: DIAMOND), taxon difference analysis (tool: Metastats), and gene annotation (tool: DIAMOND) were performed.ResultsThe microbial diversity of CDpD group was lower than that of CDnD and control groups. The abundances of 10 taxa (e.g. Deferribacteres, Cryptomycota, Acetothermia) in CDpD group were significantly higher than that in CDnD group. The abundances of Saccharomycetes and Clostridia were significantly lower in CDpD in comparison with control. A+B+, A-B+ and A-B- subgroups couldn’t be separated in principal component analysis, while some taxa are significantly different between A+B+ and A-B- subgroups.ConclusionCDpD might relate to the decrease of beneficial taxa (i.e. Saccharomycetes and Clostridia) and the increase of harmful taxa (e.g. Deferribacteres, Cryptomycota, Acetothermia) in gut microbiota in ICU patients. C. difficile type might be slightly associated with gut microbiota composition.</jats:sec

Near-Field Communications:Shape and Structure Design for Uniform Planar Array

With the flourishing development of 6G wireless networks, the demand of spectrum efficiency rapidly increases, in order to support the demands of high quality data transmission and connections of massive users. Among various promising technologies, the technology of near-field communications provides a great potential to address such an issue due to the unique spherical-wave channels for electromagnetic (EM) propagation. In this paper, multiple-input single-output (MISO) near-field communications is comprehensively studied to clarify the influences of the shape and structure of uniform planar array (UPA) on the system performance, considering three cases with uniform linear array (ULA), rectangular UPA, and circular UPA. In particular, we reveal the properties of rapid deterioration for signal-to-noise ratio (SNR) from the reduced projection aperture in near-field communications and investigate the single spherical crown antenna design and spherical crown antenna array design in order to address this issue. Moreover, we also characterize the role of antenna projection aperture in details, and theoretically analyze the shape of UPA, yielding the corresponding exact closed-form expressions for SNR and outage probability (OP). Based on these above analytical results, we find out that adjusting the spacing between adjacent antennas to control the relative angle between user and selected antennas is an efficient way to improve the projection aperture of antenna and SNR. Simulation results are shown to well match analytical results, which validate the correctness of our analysis, clarifying that our proposed designs outperform the conventional works and illustrating a better stability for angle variations.<br/

Antibiotic Resistances and Molecular Characteristics of Clostridioides difficile in ICUs in a Teaching Hospital From Central South China

Clostridioides (C.) difficile is a major healthcare-associated pathogen inducing infectious diarrhea. Approximately 25–33% of patients with antibiotic-associated diarrhea (AAD) and 90% of patients with pseudomembranous enteritis are caused by C. difficile infection (CDI). Stool samples were collected from hospitalized adults with presumptive AAD in four nonneonatal intensive care units (ICUs). Diagnosis of CDI was based on both clinical symptoms and laboratory results. The stool specimens were transferred onto CDIF (C. difficile agar), and C. difficile was finally confirmed by the latex agglutination test. Toxin-producing genes tcdA (A), tcdB (B), and cdt (CDT) were detected by PCR, and all isolates were performed multilocus sequence typing analysis. The antibiotic susceptibility of C. difficile isolates was assessed by the agar dilution method. A total of 184 C. difficile were isolated from 857 specimens in our study, the isolation rate of C. difficile was 21.5% (184/857). The 184 C. difficile were isolated from 179 patients, among these 115 patients were toxin-positive, giving the incidence of CDI being 58.0/10,000 patient days in the four ICUs. Among these 115 toxin-positive C. difficile isolates, 100 (87.0%) isolates produced two toxins (A+B+CDT-), three (2.6%) isolates were A+B+ with binary toxin-producing (A+B+CDT+), and 12 (10.4%) isolates only produced one toxin (A-B+CDT-). A total of 27 sequencing types (STs) were obtained. The most prevalent was ST3 (34 isolates), followed by ST39 (27 isolates), ST54 (19 isolates), ST26 (16 isolates), ST35 (15 isolates), and ST2 (13 isolates). All the ST26 isolates were nontoxigenic. Meanwhile, five STs were newly discovered. Although multidrug resistance was present in ≥50% of these C. difficile isolates, all of them were susceptible to tigecycline, fidaxomicin, metronidazole, and vancomycin. In conclusion, C. difficile isolates producing two toxins (A+B+CDT-) were dominant in our hospital. The most prevalent was ST3, and all ST26 isolates were NTCD. Although multidrug resistance was present in ≥50% of the C. difficile isolates, metronidazole, tigecycline, fidaxomicin, and vancomycin were still effective treatments for CDI in our hospital.</jats:p

Genome Characterization of a Novel Binary Toxin-Positive Strain of &lt;em&gt;Clostridium difficile&lt;/em&gt; and Comparison with the Epidemic 027 and 078 Strains

A novel binary toxin-positive non-027, non-078 Clostridium difficile strain designated LC693 whose sequence type was ST201 was isolated from the fecal sample of a patient with severe diarrhea in China. To understand the pathogenesis basis of C. difficile ST201, this recently recovered isolate LC693 was then chosen for whole genome sequencing. The project finally generated an estimated genome size of approximately 4.07 Mbp. The genome sequence was then analyzed together with the other two ST201 strains VL-0104 and VL-0391 and compared to the epidemic 027/ST1 and 078/ST11 strains. Phylogenetic analysis demonstrated that the ST201 strains belonged to clade 3. Genome size of the three ST201 strains ranged from 4.07 Mb~4.16 Mb, with an average GC content between 28.5%~28.9%. The ST201 genomes contained more than 40 antibiotic resistance genes and 15 of them were predicted to be associated with vancomycin-resistance, suggesting that they may have a strong antibiotic resistance. The ST201 strains contained a typical clade 3 specific PaLoc with a Tn6218 element inserted, and those genes harbored on their PaLoc that participated in the toxin expression and regulation were highly homologues to the epidemic 027 and 078 strains, with the exception of tcdC. A truncated TcdC was found in the ST201 strains, which is suggestive to have a contribution to the toxin production of the ST201 strains. In addition, the ST201 strains contained intact binary toxin coding and regulation genes, which is also proposed to contribute to the virulence. Genome comparison of the ST201 strains with the epidemic 027 and 078 strain identified 641 genes specific for the C. difficile ST201, and a number of them were predicted as fitness and virulence associated genes. The identification of those genes also contributes to the pathogenesis of the ST201 strain. To our knowledge, this is the first study that the genome sequence of C. difficile ST201 was discussed in detail, and the present study would have a contribution to understanding the pathogenesis basis of C. difficile ST201.</jats:p