According to a study published in Nature, Enterococcus, an antibiotic-resistant, opportunistic pathogen, works together with C. difficile to reshape and enhance the metabolic environment in the gut so that C. difficile can thrive.

In the study, the stool samples of 54 pediatric patients admitted to the Children’s Hospital of Philadelphia (CHOP) were collected and analyzed. These were admitted to the hospital with a C. difficile infection. The studys findings revealed that the stool samples contained high levels of Enterococcus and that there was a positive correlation between enterococcal and C. difficile burdens. The researchers also revealed that the results were consistent with the pattern observed in adults.

In the study, the researchers validated the mechanism of how these two pathogens work together using both in vitro and in vivo experimental models. They found that enterococci increase C. difficile virulence by enhancing its production of toxins. They observed that enterococci use arginine, an amino acid, for energy, and in the process of doing so, the pathogen exports ornithine, another amino acid. Further analysis showed that enterococci modulate levels of arginine and ornithine in the gut during C. difficile infection and that arginine depletion play a central role in C. difficile virulence.

Finally, the researchers looked into how their findings matched up with those of human patients. They found high levels of fermentable amino acids, including ornithine, in children with C. difficile infection and inflammatory bowel disease (IBD). 

(Source: https://theprint.in/health/study-antibiotic-resistant-microbes-in-the-gut-make-c-difficile-more-infectious/1221494/ )