Smoking and Clostridioides difficile Colonization in Adults Aged ≥40 Years: Findings from a Community-Based Gut Microbiota Study

Hong-Ming Chen,1,2,* Te-Wei Yang,3,* Wen-Chien Ko,3,4 Yuan-Pin Hung,5,6 Chin-Shiang Tsai,3,4 Pei-Jane Tsai7 1Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Yanshuei District Health Station, Tainan, Taiwan; 3Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 5Department of Microbiology and Immunology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 6Department of Internal Medicine, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan; 7Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan*These authors contributed equally to this workCorrespondence: Pei-Jane Tsai, Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Email peijtsai@mail.ncku.edu.twBackground: Asymptomatic Clostridioides difficile colonization (CdC) serves as a reservoir for pathogen transmission and may precede clinical infection. While risk factors for CdC have been well described in hospitalized populations, community-based data—particularly regarding lifestyle-associated factors and gut microbiota alterations—remain limited in Taiwan. This study aimed to determine the prevalence and risk factors of community-acquired CdC and to explore associated gut microbiota differences.Materials and Methods: We conducted a cross-sectional study analyzing 250 residual stool samples from adults aged ≥ 40 years who participated in community health screenings in Tainan City between 2006 and 2009. CdC was detected by polymerase chain reaction targeting the triosephosphate isomerase (tpi) gene. Demographic characteristics, lifestyle factors, and laboratory parameters ...