Work

Binary Toxin and Death afterClostridium difficileInfection

Year: 2011

Type: article

Abstract: We compared 30-day case-fatality rates for patients infected with Clostridium difficile possessing genes for toxins A and B without binary toxin (n = 212) with rates for patients infected with C. difficile possessing genes for A, B, and binary toxin.The latter group comprised patients infected with strains of PCR ribotype 027 (CD027, n = 193) or non-027 (CD non-027, n = 72).Patients with binary toxin had higher case-fatality rates than patients without binary toxin, in univariate analysis (relative risk [RR] 1.8, 95% confidence interval [CI] 1.2-2.7)and multivariate analysis after adjustment for age, sex, and geographic region (RR 1.6, 95% CI 1.0-2.4).Similar case-fatality rates (27.8%,28.0%) were observed for patients infected with CD027 or CD non-027.Binary toxin either is a marker for more virulent C. difficile strains or contributes directly to strain virulence.Efforts to control C. difficile infection should target all virulent strains irrespective of PCR ribotype.Clostridium difficile infection (CDI) is a common cause of health care-associated diarrhea in industrialized countries (1), and the leading cause of intestinal infection related to antimicrobial drug consumption (2).Clinical manifestations range from mild to severe diarrhea, pseudomembranous colitis, toxic megacolon, sepsis, and ultimately death.Risk factors for CDI include duration of hospital stay, underlying illness, age (3), and previous use of virtually any antimicrobial drug, most frequently cephalosporins and fluoroquinolones (4-10).The hypervirulent fluoroquinolone-resistant C. difficile PCR ribotype 027 North American pulsed-field type 1 (NAP1) (REA type BI, toxinotype III) has received attention as the cause of increasingly severe outbreaks and higher death rates, longer hospital stays, and frequent

Source: Emerging infectious diseases

DOI: 10.3201/eid/1706.101483

Authors: Sabrina Bacci, Kåre Mølbak, Marianne K. Kjeldsen, Katharina E.P. Olsen

Institution: Statens Serum Institut

Language: English

Topic: Clostridium difficile and Clostridium perfringens research

Subfield: Infectious Diseases

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funders: European Centre for Disease Prevention and Control, Statens Serum Institut