Evaluation of Clostridium difficile Infection with PET/CT Imaging in a Mouse Model

Purpose: Existing clinical or microbiological scores are not sensitive enough to obtain prompt identification of patients at risk of complicated Clostridium difficile infection (CDI). Our aim was to use a CDI animal model to evaluate 2-deoxy-2-[F]fluoro-D-glucose positron emission tomography ([F]FDG-PET) as a marker of severe course of infection. Procedures: CDI was induced with cefoperazone for 10 days followed by clindamycin 1 day before C. difficile inoculation. Mice were divided into wild type (n = 6), antibiotic without infection (AC n = 4), h001-infected (n = 5, ribotype 001), and h027-infected (n = 5, ribotype 027). Two days after inoculation, [F]FDG-PET was acquired. Weight, general animal condition, and survival were monitored daily for 9 days. Results: h001 group showed symptoms for 4 days with 0 % mortality and a similar colon uptake than control animals (h001 0.52 ± 0.20, WT 0.42 ± 0.07, and AC 0.36 ± 0.06). The h027 group showed symptoms up to 7 days, with 66.7 % of mortality 4 days after infection, and significantly higher colon uptake (0.93 ± 0.38, p < 0.05). Clinical score was associated to colon and cecum uptake (rho = 0.78, p = 0.0001) (rho = 0.73, p = 0.0003). Conclusion: High toxin producer ribotype 027 induced more severe CDI infections, correlating with higher colon and cecum [F]FDG uptake. Colon uptake may purportedly serve as early predictor of CDI severity.