A genomic analysis of Clostridium difficile infections in blunt trauma patients

Philip Alexander Efron, Huazhi Liu, Lawrence Lottenberg, Alex Gervacio Cuenca, Lori Filichia Gentile, Makesha Vernee Miggins, Azra Bihorac, Henry V. Baker, Frederick Alan Moore, Lyle Linc Moldawer, Darwin N. Ang

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

BACKGROUND: Evidence demonstrates that susceptibility to Clostridium difficile infection is related to host risk factors as much as bacterial potency. Using blood leukocyte genome-wide expression patterns of severe blunt trauma patients obtained by the National Institute of General Medical Sciences-sponsored Glue Grant Inflammation and the Host Response to Injury, we examined leukocyte genomic profiles of patients with C. difficile infection to determine preinfection and postinfection gene expression changes. METHODS: The genomic responses of 21 severe trauma patients were analyzed (5 C. difficile, 16 controls matched for age and severity of injury). After elimination of probe sets whose expression was below baseline or were unchanged, remaining probe sets underwent hierarchical clustering and principal component analysis. Molecular pathways were generated through Ingenuity Pathways Analysis. RESULTS: Supervised analysis demonstrated 118 genes whose expression in patients with C. difficile infection varied before and after their infection. Supervised analysis comparing patients with C. difficile infection with matched non-C. difficile patients before infection suggested that the expression of 501 genes were different in the two groups with up to 87% class prediction (p < 0.05). Many of these genes are related to cell-mediated immune responses, signaling, and interaction. CONCLUSION: Genomic analysis of severe blunt trauma patients reveals a distinct leukocyte expression profile of C. difficile both before and after infection. We conclude that an association may exist between a severe trauma patient's leukocyte genomic expression profile and subsequent susceptibility to C. difficile infection. Further prospective expression analysis of this C. difficile population may reveal potential therapeutic interventions and allow early identification of C. difficile-susceptible patients. LEVEL OF EVIDENCE: Prognostic/diagnostic study, level III.

Original languageEnglish (US)
Pages (from-to)334-338
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number1
DOIs
StatePublished - Jan 2013
Externally publishedYes

Keywords

  • Clostridium difficile
  • Genomics
  • leukocyte
  • microarray
  • trauma

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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