Research Papers:

Clostridium difficile colonization in preoperative colorectal cancer patients

Yi Zheng _, Yun Luo, Yinxiang Lv, Chen Huang, Qinsong Sheng, Peng Zhao, Julian Ye, Weiqin Jiang, Lulu Liu, Xiaojun Song, Zhou Tong, Wenbin Chen, Jianjiang Lin, Yi-Wei Tang, Dazhi Jin and Weijia Fang

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Oncotarget. 2017; 8:11877-11886. https://doi.org/10.18632/oncotarget.14424

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Yi Zheng1,*, Yun Luo2,*, Yinxiang Lv3, Chen Huang2, Qinsong Sheng4, Peng Zhao1, Julian Ye2, Weiqin Jiang1, Lulu Liu1, Xiaojun Song2, Zhou Tong1, Wenbin Chen4, Jianjiang Lin4, Yi-Wei Tang5, Dazhi Jin2, Weijia Fang1

1Cancer Biotherapy Center, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

2Department of Microbiology, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China

3Xinchang People’s Hospital, Shaoxing, China

4Department of Colorectal Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China

5Department 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: [email protected]

Weijia Fang, email: [email protected]

Keywords: Clostridium difficile, colorectal cancer, colonization, epidemiology, transmission

Received: November 02, 2016    Accepted: December 20, 2016    Published: January 02, 2017


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.

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