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J Gastrointest Surg. 2013 Jan;17(1):118-24; discussion p.124-5. doi: 10.1007/s11605-012-2056-6. Epub 2012 Oct 20.

Predicting recurrence of C. difficile colitis using bacterial virulence factors: binary toxin is the key.

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Department of Surgery, Penn State College of Medicine, 500 University Drive, H137, Hershey, PA 17033, USA.



Recurrent Clostridium difficile colitis is common, yet the ability to predict recurrence is poorly developed.


Patients ≥18 years of age treated at our institution for C. difficile of any severity were consecutively enrolled. C. difficile colitis was defined as symptoms of colitis with a positive PCR stool test. Each bacterial isolate was studied for virulence factors: tcdC mutations via PCR; the presence of genes for toxins A, B, and binary toxin using restriction fragment length polymorphism; and identification of ribotype 027 by PCR. Chi-squared tests, t tests, and logistic and linear regression were used to determine which virulence factors predicted recurrence.


Sixty-nine patients (male, 57 %) were studied, with a mean age of 64 ± 13 years. Twenty-one (30 %) patients were initially diagnosed as outpatients. There was no difference (p > 0.05) between virulence factors among inpatients and outpatients. The presence of a binary toxin gene was the single virulence factor independently associated with recurrence (p = 0.02). The combination of a tcdC mutation with binary toxin gene resulted in the highest odds of recurrence (OR, 5.3; 95 % CI, 3.52-6.09).


Binary toxin gene is a predictor of recurrent infection. Its presence may require longer antibiotic regimens in an effort to lower already elevated recurrence rates.

[Indexed for MEDLINE]

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