Role of competition for nutrients in suppression of Clostridium difficile by the colonic microflora.

The cecal flora of mice is able to eliminate Clostridium difficile from the mouse cecum even when C. difficile is the first organism established. We used a continuous-flow (CF) culture model of the cecal flora to investigate the possibility that competition for nutrients is one mechanism for this antagonism. The medium for the CF cultures consisted of homogenates of fecal pellets from germfree mice. Carbohydrate analysis showed that mouse flora depleted 74 to 99.8% of the various carbohydrates from this environment-simulating medium. When inoculated into filtrates made from CF cultures of mouse flora, C. difficile multiplied slower than the dilution rate of the CF cultures unless glucose, N-acetylglucosamine, or N-acetylneuraminic acid was added. C. difficile did not synthesize hydrolytic enzymes able to cleave these monosaccharides from oligosaccharide side chains. As found previously, veal infusion broth did not support the growth of a microflora that could be transferred to gnotobiotic mice and fully suppress C. difficile. When mucin or monosaccharides found in mucin were added to veal infusion broth, the flora functioned normally in this regard. These data suggest that as yet unidentified organisms compete more efficiently than C. difficile for monomeric glucose, N-acetylglucosamine, and sialic acids found in colonic contents.