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Clin Gastroenterol Hepatol. 2009 Aug;7(8):868-873.e2. doi: 10.1016/j.cgh.2009.05.018. Epub 2009 May 22.

Clostridium difficile strain NAP-1 is not associated with severe disease in a nonepidemic setting.

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Division of Gastroenterology and Hepatology, University of Virginia Medical Center, Charlottesville, Virginia, USA.



Recent outbreaks of Clostridium difficile infection (CDI) in North America and in Europe with very high case-fatality rates have been associated with infection by North American Pulsed Field Type I (NAP-1) isolates. This study examined whether NAP-1 strains are associated with worse outcomes of CDI in a nonepidemic, nosocomial setting.


All cases of CDI that occurred over a 13-month period at a tertiary medical center were examined for risk factors associated with increased severity of CDI and other outcomes. Stool samples from each patient were cultured for C difficile and the resulting isolates were strain-typed by pulsed-field gel electrophoresis.


Strain types were obtained from 236 of 272 CDI samples; the NAP-1 strain was identified in 59 (25%). In this inpatient cohort of patients with CDI, the incidence of in hospital death was 12.1% and of death caused by CDI was 4.0%. Of the patients with CDI, 22.1% met the combined outcome end point of severe CDI. In both univariate and multivariate analyses, patients infected with the NAP-1 strain did not have worse outcomes compared with those infected with non-NAP-1 strains. Infection with the NAP-1 strain was correlated with admission from outside health care facilities regardless of whether symptoms of CDI began before or after admission to the study hospital.


The NAP-1 strain of C difficile was found to cause 25% of cases of CDI in the hospital where the study was performed. However, compared with non-NAP-1 strains, CDI was not associated with increased severity of disease in this nonepidemic setting.

[Indexed for MEDLINE]

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