Non-toxigenic Clostridioides difficile strain E4 (NTCD-E4) prevents establishment of primary C. 1 difficile infection by epidemic PCR ribotype 027 in an in vitro human gut model

Clostridioides difficile infection (CDI) remains a significant worldwide healthcare burden. C. difficile is uniquely adapted to the GI tract, where the unperturbed indigenous microbiotas prevent colonisation and CDI. Antimicrobials perturb the gut microbiota and facilitate CDI, with recurrent CDI (rCDI) remaining a clinical issue, particularly with epidemic C. difficile ribotypes (RT). Non-toxigenic C. difficile (NTCD) have shown benefit in preventing porcine enteritis and in human rCDI trials and animal CDI models. In this study, we evaluated the efficacy of NTCD in preventing CDI facilitated by a range of antimicrobials, in an in-vitro human gut model.