Format

Send to

Choose Destination
Clin Infect Dis. 2015 Jul 15;61(2):233-41. doi: 10.1093/cid/civ254. Epub 2015 Mar 31.

Clostridium difficile ribotype 027: relationship to age, detectability of toxins A or B in stool with rapid testing, severe infection, and mortality.

Author information

1
Division of Infectious Diseases Department of Internal Medicine Division of Infectious Diseases, Veterans Affairs Ann Arbor Healthcare System, Michigan.
2
Department of Internal Medicine, Section of Gastroenterology, Hepatology, and Nutrition, University of Chicago, Illinois.
3
Department of Internal Medicine.
4
Department of Clinical Pathology.
5
Department of Microbiology and Immunology, Montana State University, Bozeman.
6
Division of Infectious Diseases Department of Internal Medicine.
7
Division of Geriatric Medicine Department of Biostatistics, University of Michigan School of Medicine, Ann Arbor.
8
Division of Gastroenterology Department of Internal Medicine.
9
Division of Infectious Diseases Department of Internal Medicine Department of Microbiology and Immunology.
10
Division of Infectious Diseases Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.

Abstract

BACKGROUND:

Clostridium difficile infection (CDI) can cause severe disease and death, especially in older adults. A better understanding of risk factors for adverse outcomes is needed. This study tests the hypotheses that infection with specific ribotypes and presence of stool toxins independently associate with severity and constructs predictive models of adverse outcomes.

METHODS:

Cases of non-recurrent CDI were prospectively included after positive stool tests for toxins A and/or B by enzyme immunoassay (EIA) or tcdB by polymerase chain reaction. Outcomes included severe CDI (intensive care unit admission, colectomy, or death attributable to CDI within 30 days of diagnosis) and 30-day all-cause mortality. Adjusted models were developed to test hypotheses and predict outcomes.

RESULTS:

In total, 1144 cases were included. The toxin EIA was positive in 37.2% and 35.6% of patients were of age >65 years. One of the 137 unique ribotypes was ribotype 027 (16.2%). Detectable stool toxin did not associate with outcomes. Adjusting for covariates, including age, Ribotype 027 was a significant predictor of severe CDI (90 cases; odds ratio [OR], 1.73; 95% confidence interval [CI], 1.03-2.89; P = .037) and mortality (89 cases; OR, 2.02; 95% CI, 1.19-3.43; P = .009). Concurrent antibiotic use associated with both outcomes. Both multivariable predictive models had excellent performance (area under the curve >0.8).

CONCLUSIONS:

Detection of stool toxin A and/or B by EIA does not predict severe CDI or mortality. Infection with ribotype 027 independently predicts severe CDI and mortality. Use of concurrent antibiotics is a potentially modifiable risk factor for severe CDI.

KEYWORDS:

Clostridium difficile infection; colitis; ribotype; risk prediction models

PMID:
25828993
PMCID:
PMC4565993
DOI:
10.1093/cid/civ254
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center