Innate Immune Response to CDI May Be Preserved in Immunocompromised Patients

Among immunocompromised individuals, innate immune responses to Clostridioides difficile infection (CDI) may be preserved, according to results of a study published in Open Forum Infectious Diseases.

Patients (N=123) hospitalized at Beth Israel Deaconess Medical Center and Texas Medical Center with CDI confirmed via nucleic acid amplification testing were prospectively enrolled for this study between 2016 and 2020. Researchers aimed to evaluate whether there is a relationship between the innate immune response to CDI and immunocompromised status. Cytokine levels in blood and stool samples at CDI diagnosis were compared among patients with and without immunosuppression and those who were asymptomatic carriers.

The study population included patients who were (n=42) and were not (n=50) immunocompromised and those who were asymptomatic carriers (n=31). Among patients in these 3 groups, 50%, 36%, and 54.8% were men; the median age was 67, 63, and 64 years; and 88.1%, 90%, and 61.7% were White, respectively.

Among patients in the immunocompromised group, 26.2% had active hematologic malignancy, 16.7% had solid tumors and had received recent chemotherapy, and 16.7% were receiving high-dose steroids. There were 10 immunocompromised patients in the asymptomatic carrier group, 5 of whom had solid tumors and had received recent chemotherapy (n=5).

Blood panel results showed significant between-group differences in interleukin (IL)-4, IL-6, IL-8, IL-10, IL-15; granulocyte colony-stimulating factor (G-CSF); and tumor necrosis factor (TNF)-α levels (all P £.038). Further analysis of stool samples showed between-group differences in IL-1β, IL-8, IL-10, IL-15, and G-CSF levels. However, after Bonferroni correction, only levels of IL-6, IL-8, IL-10, IL-15, and G-CSF observed in blood panel results and levels of IL-8 and IL-1β observed in stool sample analyses remained significantly different between the groups.

In Bonferroni-corrected pairwise comparisons, the only marker that remained significantly different between patients who were and were not immunocompromised was IL-10 levels observed in stool samples (median, 1.24 vs 1.24 pg/mL; P =.005).

Differences observed between patients who were and were not immunocomprised and those who were asymptomatic carriers comprised the majority of those observed among all groups in the 3-way comparison analysis. After Bonferroni correction, 5 cytokines in blood samples and 2 in stool samples remained significantly different between asymptomatic carriers vs both immunocompromised patients and those who were not immunocompromised.

However, among asymptomatic carriers, no significant differences in any of the 8 tested cytokines were observed between the subset of patients who were and were not immunocompromised.

Study limitations include heterogeneity and the inability to draw specific conclusions about the effect of a single class of immunosuppressant agents on cytokine response to CDI.

According to the researchers, [T]hese data may open the door for establishing approaches to CDI diagnosis that will be broadly applicable to special patient populations such as oncology and transplant recipients.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.