The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome
Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization. We collec...
Ausführliche Beschreibung
Autor*in: |
John P. Haran [verfasserIn] Doyle V. Ward [verfasserIn] Shakti K. Bhattarai [verfasserIn] Ethan Loew [verfasserIn] Protiva Dutta [verfasserIn] Amanda Higgins [verfasserIn] Beth A. McCormick [verfasserIn] Vanni Bucci [verfasserIn] |
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E-Artikel |
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Sprache: |
Englisch |
Erschienen: |
2021 |
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Schlagwörter: |
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Übergeordnetes Werk: |
In: Gut Microbes - Taylor & Francis Group, 2020, 13(2021), 1 |
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Übergeordnetes Werk: |
volume:13 ; year:2021 ; number:1 |
Links: |
Link aufrufen |
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DOI / URN: |
10.1080/19490976.2021.1897209 |
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Katalog-ID: |
DOAJ017414016 |
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10.1080/19490976.2021.1897209 doi (DE-627)DOAJ017414016 (DE-599)DOAJa3075ec192be4537983a04141751499e DE-627 ger DE-627 rakwb eng RC799-869 John P. Haran verfasserin aut The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization. We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history. We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22–0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence. C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH. clostridioides difficile colonization nursing home elders gut microbiome proton pump inhibitor dysbiosis bile acids Diseases of the digestive system. Gastroenterology Doyle V. Ward verfasserin aut Shakti K. Bhattarai verfasserin aut Ethan Loew verfasserin aut Protiva Dutta verfasserin aut Amanda Higgins verfasserin aut Beth A. McCormick verfasserin aut Vanni Bucci verfasserin aut In Gut Microbes Taylor & Francis Group, 2020 13(2021), 1 (DE-627)635932830 (DE-600)2575755-6 19490984 nnns volume:13 year:2021 number:1 https://doi.org/10.1080/19490976.2021.1897209 kostenfrei https://doaj.org/article/a3075ec192be4537983a04141751499e kostenfrei http://dx.doi.org/10.1080/19490976.2021.1897209 kostenfrei https://doaj.org/toc/1949-0976 Journal toc kostenfrei https://doaj.org/toc/1949-0984 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2021 1 |
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10.1080/19490976.2021.1897209 doi (DE-627)DOAJ017414016 (DE-599)DOAJa3075ec192be4537983a04141751499e DE-627 ger DE-627 rakwb eng RC799-869 John P. Haran verfasserin aut The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization. We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history. We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22–0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence. C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH. clostridioides difficile colonization nursing home elders gut microbiome proton pump inhibitor dysbiosis bile acids Diseases of the digestive system. Gastroenterology Doyle V. Ward verfasserin aut Shakti K. Bhattarai verfasserin aut Ethan Loew verfasserin aut Protiva Dutta verfasserin aut Amanda Higgins verfasserin aut Beth A. McCormick verfasserin aut Vanni Bucci verfasserin aut In Gut Microbes Taylor & Francis Group, 2020 13(2021), 1 (DE-627)635932830 (DE-600)2575755-6 19490984 nnns volume:13 year:2021 number:1 https://doi.org/10.1080/19490976.2021.1897209 kostenfrei https://doaj.org/article/a3075ec192be4537983a04141751499e kostenfrei http://dx.doi.org/10.1080/19490976.2021.1897209 kostenfrei https://doaj.org/toc/1949-0976 Journal toc kostenfrei https://doaj.org/toc/1949-0984 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2021 1 |
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10.1080/19490976.2021.1897209 doi (DE-627)DOAJ017414016 (DE-599)DOAJa3075ec192be4537983a04141751499e DE-627 ger DE-627 rakwb eng RC799-869 John P. Haran verfasserin aut The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization. We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history. We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22–0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence. C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH. clostridioides difficile colonization nursing home elders gut microbiome proton pump inhibitor dysbiosis bile acids Diseases of the digestive system. Gastroenterology Doyle V. Ward verfasserin aut Shakti K. Bhattarai verfasserin aut Ethan Loew verfasserin aut Protiva Dutta verfasserin aut Amanda Higgins verfasserin aut Beth A. McCormick verfasserin aut Vanni Bucci verfasserin aut In Gut Microbes Taylor & Francis Group, 2020 13(2021), 1 (DE-627)635932830 (DE-600)2575755-6 19490984 nnns volume:13 year:2021 number:1 https://doi.org/10.1080/19490976.2021.1897209 kostenfrei https://doaj.org/article/a3075ec192be4537983a04141751499e kostenfrei http://dx.doi.org/10.1080/19490976.2021.1897209 kostenfrei https://doaj.org/toc/1949-0976 Journal toc kostenfrei https://doaj.org/toc/1949-0984 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2021 1 |
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10.1080/19490976.2021.1897209 doi (DE-627)DOAJ017414016 (DE-599)DOAJa3075ec192be4537983a04141751499e DE-627 ger DE-627 rakwb eng RC799-869 John P. Haran verfasserin aut The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization. We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history. We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22–0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence. C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH. clostridioides difficile colonization nursing home elders gut microbiome proton pump inhibitor dysbiosis bile acids Diseases of the digestive system. Gastroenterology Doyle V. Ward verfasserin aut Shakti K. Bhattarai verfasserin aut Ethan Loew verfasserin aut Protiva Dutta verfasserin aut Amanda Higgins verfasserin aut Beth A. McCormick verfasserin aut Vanni Bucci verfasserin aut In Gut Microbes Taylor & Francis Group, 2020 13(2021), 1 (DE-627)635932830 (DE-600)2575755-6 19490984 nnns volume:13 year:2021 number:1 https://doi.org/10.1080/19490976.2021.1897209 kostenfrei https://doaj.org/article/a3075ec192be4537983a04141751499e kostenfrei http://dx.doi.org/10.1080/19490976.2021.1897209 kostenfrei https://doaj.org/toc/1949-0976 Journal toc kostenfrei https://doaj.org/toc/1949-0984 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 13 2021 1 |
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John P. Haran @@aut@@ Doyle V. Ward @@aut@@ Shakti K. Bhattarai @@aut@@ Ethan Loew @@aut@@ Protiva Dutta @@aut@@ Amanda Higgins @@aut@@ Beth A. McCormick @@aut@@ Vanni Bucci @@aut@@ |
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2021-01-01T00:00:00Z |
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John P. Haran misc RC799-869 misc clostridioides difficile colonization misc nursing home elders misc gut microbiome misc proton pump inhibitor misc dysbiosis misc bile acids misc Diseases of the digestive system. Gastroenterology The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome |
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RC799-869 The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome clostridioides difficile colonization nursing home elders gut microbiome proton pump inhibitor dysbiosis bile acids |
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high prevalence of clostridioides difficile among nursing home elders associates with a dysbiotic microbiome |
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The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome |
abstract |
Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization. We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history. We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22–0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence. C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH. |
abstractGer |
Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization. We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history. We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22–0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence. C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH. |
abstract_unstemmed |
Clostridioides difficile disproportionally affects the elderly living in nursing homes (NHs). Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization. We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history. We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22–0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence. C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH. |
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The high prevalence of Clostridioides difficile among nursing home elders associates with a dysbiotic microbiome |
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Our objective was to explore the prevalence of C. difficile in NH elders, over time and to determine whether the microbiome or other clinical factors are associated with C. difficile colonization. We collected serial stool samples from NH residents. C. difficile prevalence was determined by quantitative polymerase-chain reaction detection of Toxin genes tcdA and tcdB; microbiome composition was determined by shotgun metagenomic sequencing. We used mixed-effect random forest modeling machine to determine bacterial taxa whose abundance is associated with C. difficile prevalence while controlling for clinical covariates including demographics, medications, and past medical history. We enrolled 167 NH elders who contributed 506 stool samples. Of the 123 elders providing multiple samples, 30 (24.4%) elders yielded multiple samples in which C. difficile was detected and 78 (46.7%) had at least one C. difficile positive sample. Elders with C. difficile positive samples were characterized by increased abundances of pathogenic or inflammatory-associated bacterial taxa and by lower abundances of taxa with anti-inflammatory or symbiotic properties. Proton pump inhibitor (PPI) use is associated with lower prevalence of C. difficile (Odds Ratio 0.46; 95%CI, 0.22–0.99) and the abundance of bacterial species with known beneficial effects was higher in PPI users and markedly lower in elders with high C. difficile prevalence. C. difficile is prevalent among NH elders and a dysbiotic gut microbiome associates with C. difficile colonization status. Manipulating the gut microbiome may prove to be a key strategy in the reduction of C. difficile in the NH.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">clostridioides difficile colonization</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">nursing home elders</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">gut microbiome</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">proton pump inhibitor</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">dysbiosis</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">bile acids</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Diseases of the digestive system. Gastroenterology</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Doyle V. 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