In the Endemic Setting, Clostridium difficile Ribotype 027 Is Virulent But Not Hypervirulent
| Autor: | Samuel L, Aitken, M Jahangir, Alam, Mohammed, Khaleduzzaman, Mohammed, Khaleduzzuman, Seth T, Walk, William L, Musick, Vy P, Pham, Jennifer L, Christensen, Robert L, Atmar, Yang, Xie, Kevin W, Garey |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Microbiology (medical) medicine.medical_specialty Toxic megacolon Ileus Epidemiology medicine.medical_treatment Ribotyping Severity of Illness Index Article Microbiology Internal medicine Odds Ratio medicine Humans Prospective Studies Hypoalbuminemia Leukocytosis Aged Colectomy Aged 80 and over Cross Infection Clostridioides difficile business.industry Odds ratio Middle Aged Clostridium difficile medicine.disease Texas Hospitals Logistic Models Infectious Diseases Multivariate Analysis Clostridium Infections Female medicine.symptom business |
| Zdroj: | Infection Control & Hospital Epidemiology. 36:1318-1323 |
| ISSN: | 1559-6834 0899-823X |
| DOI: | 10.1017/ice.2015.187 |
| Popis: | BACKGROUNDConflicting reports have been published on the association between Clostridium difficile ribotypes and severe disease outcomes in patients with C. difficile infection (CDI); several so-called hypervirulent ribotypes have been described. We performed a multicenter study to assess severe disease presentation and severe outcomes among CDI patients infected with different ribotypes.METHODSStool samples that tested positive for C. difficile toxin were collected and cultured from patients who presented to any of 7 different hospitals in Houston, Texas (2011–2013). C. difficile was characterized using a fluorescent PCR ribotyping method. Medical records were reviewed to determine clinical characteristics and ribotype association with severe CDI presentation (ie, leukocytosis and/or hypoalbuminemia) and severe CDI outcomes (ie, ICU admission, ileus, toxic megacolon, colectomy, and/or in-hospital death).RESULTSOur study included 715 patients aged 61±18 years (female: 63%; median Charlson comorbidity index: 2.5±2.4; hospital-onset CDI: 45%; severe CDI: 36.7%; severe CDI outcomes: 12.3%). The most common ribotypes were 027, 014-020, FP311, 002, 078-126, and 001. Ribotype 027 was a significant independent predictor of severe disease (adjusted odds ratio [aOR], 2.24; 95% confidence interval [CI], 1.53–3.29; PP=.041) compared with all other ribotypes in aggregate. However, in an analysis using all common ribotypes as individual variables, ribotype 027 was not associated with severe CDI outcomes more often than other ribotypes.CONCLUSIONRibotype 027 showed virulence equal to that of other ribotypes identified in this endemic setting. Clinical severity markers of CDI may be more predictive of severe CDI outcomes than a particular ribotype.Infect. Control Hosp. Epidemiol. 2015;36(11):1318–1323 |
| Databáze: | OpenAIRE |
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