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Role of binary toxin in the outcome of Clostridium difficile infection in a non-027 ribotype setting

  • E. REIGADAS (a1) (a2) (a3), L. ALCALÁ (a1) (a3) (a4), M. MARÍN (a1) (a2) (a3) (a4), A. MARTÍN (a1) (a3), C. IGLESIAS (a1) (a3) (a4) and E. BOUZA (a1) (a2) (a3) (a4)...

Summary

Binary toxin (BT) has been associated with strains causing more severe Clostridium difficile infection (CDI), such as ribotype 027. Data on the outcome of patients having BT present in ribotypes other than 027 are scarce. Our objective was to investigate the association between BT isolates and outcome of CDI in a non-027 ribotype setting. We prospectively included CDI episodes (January–June 2013 and March–June 2014) from symptomatic patients aged >2 years. Epidemiological and clinical data were recorded. BT genes were detected using multiplex PCR. During the study period, we identified 326 episodes of CDI, of which 319 were available for molecular analysis. Of these, 54 (16·9%) were caused by C. difficile strains with BT. Most (90·7%) isolates with BT were ribotype 078/126. CDI patients with BT-positive strains did not differ from those with BT-negative strains in terms of recurrence (13·0% vs. 15·5%, P = 0·835), treatment failure (0·0% vs. 2·3%, P = 0·594), overall mortality (11·1% vs. 9·1%, P = 0·612), or CDI-related mortality (0·0% vs. 1·9%, P = 0·612). Multivariate regression revealed no association between BT and poor outcome. In conclusion, in a non-027 setting, we found that most BT isolates were 078/126 and were not associated with poor outcome.

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Corresponding author

* Author for correspondence: E. Reigadas, PharmD, Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario ‘Gregorio Marañón’, C/ Dr. Esquerdo, 46, 28007 Madrid, Spain. (Email: helenrei@hotmail.com) (Email: emilio.bouza@gmail.com)

References

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1. Dubberke, ER, Olsen, MA. Burden of Clostridium difficile on the healthcare system. Clinical Infectious Diseases 2012; 55 (Suppl. 2): S8892.
2. Wiegand, PN, et al. Clinical and economic burden of Clostridium difficile infection in Europe: a systematic review of healthcare-facility-acquired infection. Journal of Hospital Infection 2012; 81: 114.
3. Asensio, A, et al. Cost of Clostridium difficile associated diarrhoea in Spain [in Spanish]. Revista Española de Salud Pública 2013; 87: 2533.
4. Miller, MA, et al. Morbidity, mortality, and healthcare burden of nosocomial Clostridium difficile-associated diarrhoea in Canadian hospitals. Infection Control & Hospital Epidemiology 2002; 23: 137140.
5. Henrich, TJ, et al. Clinical risk factors for severe Clostridium difficile-associated disease. Emerging Infectious Diseases 2009; 15: 415422.
6. Hensgens, MP, et al. Predicting a complicated course of Clostridium difficile infection at the bedside. Clinical Microbiology and Infection 2014; 20: 301308.
7. Lungulescu, OA, et al. CSI: a severity index for Clostridium difficile infection at the time of admission. Journal of Hospital Infection 2011; 79: 151154.
8. McFarland, LV, et al. Recurrent Clostridium difficile disease: epidemiology and clinical characteristics. Infection Control & Hospital Epidemiology 1999; 20: 4350.
9. Voth, DE, Ballard, JD. Clostridium difficile toxins: mechanism of action and role in disease. Clinical Microbiology Reviews 2005; 18: 247263.
10. Goncalves, C, et al. Prevalence and characterization of a binary toxin (actin-specific ADP-ribosyltransferase) from Clostridium difficile . Journal of Clinical Microbiology 2004; 42: 19331939.
11. Barbut, F, et al. Prospective study of Clostridium difficile infections in Europe with phenotypic and genotypic characterisation of the isolates. Clinical Microbiology and Infection 2007; 13: 10481057.
12. Warny, M, et al. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005; 366: 10791084.
13. Kuijper, EJ, et al. Emergence of Clostridium difficile-associated disease in North America and Europe. Clinical Microbiology and Infection 2006; 12 (Suppl. 6): 218.
14. Cohen, SH, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infection Control & Hospital Epidemiology 2010; 31: 431455.
15. Charlson, ME, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases 1987; 40: 373383.
16. McCabe, WR, Jackson, GG. Gram-negative bacteremia: I. Etiology and ecology. Archives of Internal Medicine 1962; 110: 847855.
17. Persson, S, et al. New multiplex PCR method for the detection of Clostridium difficile toxin A (tcdA) and toxin B (tcdB) and the binary toxin (cdtA/cdtB) genes applied to a Danish strain collection. Clinical Microbiology and Infection 2008; 14: 10571064.
18. Lemee, L, et al. Multiplex PCR targeting tpi (triose phosphate isomerase), tcdA (toxin A), and tcdB (toxin B) genes for toxigenic culture of Clostridium difficile . Journal of Clinical Microbiology 2004; 42: 57105714.
19. Stubbs, SL, et al. PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes. Journal of Clinical Microbiology 1999; 37: 461463.
20. Popoff, MR, et al. Actin-specific ADP-ribosyltransferase produced by a Clostridium difficile strain. Infection and Immunity 1988; 56: 22992306.
21. Stubbs, S, et al. Production of actin-specific ADP-ribosyltransferase (binary toxin) by strains of Clostridium difficile . FEMS Microbiology Letters 2000; 186: 307312.
22. McDonald, LC, et al. An epidemic, toxin gene-variant strain of Clostridium difficile . New England Journal of Medicine 2005; 353: 24332441.
23. Loo, VG, et al. A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhoea with high morbidity and mortality. New England Journal of Medicine 2005; 353: 24422449.
24. Barbut, F, et al. Clinical features of Clostridium difficile-associated infections and molecular characterization of strains: results of a retrospective study, 2000–2004. Infection Control & Hospital Epidemiology 2007; 28: 131139.
25. Alcala, L, et al. The undiagnosed cases of Clostridium difficile infection in a whole nation: where is the problem? Clinical Microbiology and Infection 2012; 18: E204213.
26. Davies, KA, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infectious Diseases 2014; 14: 12081219.
27. Alcala, L, et al. and the Spanish Clostridium difficile Study Group. Multicentre study of Clostridium difficile infection in Spain (studies II and III): updating the evolution of underdiagnosis of Clostridium difficile infection in a whole nation. 24th European Congress of Clinical Microbiology and Infectious Diseases Barcelona, Spain, 2014.
28. Goorhuis, A, et al. Emergence of Clostridium difficile infection due to a new hypervirulent strain, polymerase chain reaction ribotype 078. Clinical Infectious Diseases 2008; 47: 11621170.
29. Walk, ST, et al. Clostridium difficile ribotype does not predict severe infection. Clinical Infectious Diseases 2012; 55: 16611668.
30. Sirard, S, et al. Lack of association between clinical outcome of Clostridium difficile infections, strain type, and virulence-associated phenotypes. Journal of Clinical Microbiology 2011; 49: 40404046.
31. Barbut, F, et al. Clinical features of Clostridium difficile-associated diarrhoea due to binary toxin (actin-specific ADP-ribosyltransferase)-producing strains. Journal of Medical Microbiology 2005; 54: 181185.
32. Kim, J, et al. Clinical and microbiologic characteristics of Clostridium difficile infection caused by binary toxin producing strain in Korea. Infection & Chemotherapy 2013; 45: 175183.
33. Stewart, DB, et al. Predicting recurrence of C. difficile colitis using bacterial virulence factors: binary toxin is the key. Journal of Gastrointestinal Surgery 2013; 17: 118124 (discussion 124–115).
34. Goldenberg, SD, French, GL. Lack of association of tcdC type and binary toxin status with disease severity and outcome in toxigenic Clostridium difficile . Journal of Infection 2011; 62: 355362.
35. Bacci, S, et al. Binary toxin and death after Clostridium difficile infection. Emerging Infectious Diseases 2011; 17: 976982.

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