ArticlePloS one2019
High sporulation and overexpression of virulence factors in biofilms and reduced susceptibility to vancomycin and linezolid in recurrent Clostridium [Clostridioides] difficile infection isolates.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
20 citing papers in PubMed, 24 citations in OpenAlex.
- A longitudinal analysis of Clostridioides difficile virulence profiles across three geographic regions in Israel (2020-2022).Annals of clinical microbiology and antimicrobials · 2026Article
- Whole-genome characteristics of isolates from recurrentMicrobiology spectrum · 2026Article
- Antimicrobial Susceptibility ofAntibiotics (Basel, Switzerland) · 2026Article
- Differences in virulence and drug resistance betweenVirulence · 2025Article
- Review
- Regulatory networks: Linking toxin production and sporulation in Clostridioides difficile.Anaerobe · 2025Review
- RelQ-mediated alarmone signalling regulates growth, stress-induced biofilm formation and spore accumulation inMicrobiology (Reading, England) · 2024Article
- RelQ-mediated alarmone signaling regulates growth, sporulation, and stress-induced biofilm formation inbioRxiv : the preprint server for biology · 2024Article
- Review of the Impact of Biofilm Formation on RecurrentMicroorganisms · 2023Review
- Biofilm Formation ofMicroorganisms · 2023Review
- Pre-colonization with the fungusmSphere · 2023Article
- Article
- Characterization of community-acquiredFrontiers in microbiology · 2023Article
- Genetic Mechanisms of Vancomycin Resistance inAntibiotics (Basel, Switzerland) · 2022Review
- Quorum sensing in human gut and food microbiomes: Significance and potential for therapeutic targeting.Frontiers in microbiology · 2022Review
- Analyses of publicly availableVirulence · 2021Article
- Biofilm regulation in Clostridioides difficile: Novel systems linked to hypervirulence.PLoS pathogens · 2021Review
- Antibiotic Resistance and Biofilm Production Capacity inFrontiers in cellular and infection microbiology · 2021Article
- Treatment issues in recurrentFEMS microbes · 2020Review
- Virulence Factors ofThe Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale · 2019Review
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Clostridium [Clostridioides] difficile infection (CDI) is one of the leading causes of diarrhea associated with medical care worldwide, and up to 60% of patients with CDI can develop a recurrent infection (R-CDI). A multi-species microbiota biofilm model of C. difficile was designed to evaluate the differences in the production of biofilms, sporulation, susceptibility to drugs, expression of sporulating (sigH, spo0A), quorum sensing (agrD1, and luxS), and adhesion-associated (slpA and cwp84) pathway genes between selected C. difficile isolates from R-CDI and non-recurrent patients (NR-CDI). We obtained 102 C. difficile isolates from 254 patients with confirmed CDI (66 from NR-CDI and 36 from R-CDI). Most of the isolates were biofilm producers, and most of the strains were ribotype 027 (81.374%, 83/102). Most C. difficile isolates were producers of biofilm (100/102), and most were strongly adherent. Sporulation was higher in the R-CDI than in the NR-CDI isolates (p = 0.015). The isolates from R-CDI patients more frequently demonstrated reduced susceptibility to vancomycin than isolates of NR-CDI patients (27.78% [10/36] and 9.09% [6/66], respectively, p = 0.013). The minimum inhibitory concentrations for vancomycin and linezolid against biofilms (BMIC) were up to 100 times and 20 times higher, respectively, than the corresponding planktonic MICs. Expression of sigH, spo0A, cwp84, and agrD1 was higher in R-CDI than in NR-CDI isolates. Most of the C. difficile isolates were producers of biofilms with no correlation with the ribotype. Sporulation was greater in R-CDI than in NR-CDI isolates in the biofilm model of C. difficile. The R-CDI isolates more frequently demonstrated reduced susceptibility to vancomycin and linezolid than the NR-CDI isolates in both planktonic cells and biofilm isolates. A higher expression of sporulating pathway (sigH, spo0A), quorum sensing (agrD1), and adhesion-associated (cwp84) genes was found in R-CDI than in NR-CDI isolates. All of these factors can have effect on the recurrence of the infection.
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