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Clostridium difficileInfection (CDI) Severity and Outcome among Patients Infected with the NAP1/BI/027 Strain in a Non-Epidemic Setting

Published online by Cambridge University Press:  22 December 2014

T. Scardina ,
L. Labuszewski ,
S.M. Pacheco ,
W. Adams ,
P. Schreckenberger  and
S. Johnson
T. Scardina*
Affiliation:
Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
L. Labuszewski
Affiliation:
Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
S.M. Pacheco
Affiliation:
Edward Hines Jr. VA Hospital, Hines, Illinois, USA Department of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois, USA
W. Adams
Affiliation:
Loyola University Chicago, Chicago, Illinois, USA
P. Schreckenberger
Affiliation:
Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
S. Johnson
Affiliation:
Edward Hines Jr. VA Hospital, Hines, Illinois, USA Department of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois, USA
*
Address correspondence to Tonya Scardina, PharmD, 2160 South First Avenue, Maywood, Illinois 60153 (tscardina@lumc.edu).
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Abstract

OBJECTIVE

Determine whether the NAP1 strain identified by polymerase chain reaction (PCR)-based stool assay is correlated with CDI severity and clinical outcomes.

METHODS

Medical records of adult patients with positive stool Xpert® Clostridium difficile PCR assay for an initial episode of CDI between January 2012 and January 2013 at a tertiary care hospital in Chicago were reviewed. Two patients diagnosed with CDI caused by a non-NAP1 strain (positive Xpert® C. difficile assay but negative Xpert® C. difficile Epi assay) were included for each patient diagnosed with CDI caused by a NAP1 strain (positive Epi assay). Patient charts were reviewed for markers of severity, risk factors, treatment regimens, and outcomes.

RESULTS

Of 494 stool specimens, 90 (18%) that were positive for C. difficile by PCR were positive for NAP1 strain. In total, 37 patients with CDI due to NAP1 were matched with 74 patients with CDI due to non-NAP1 strains. Multivariable model revealed individuals ≥65 years old were 3 times more likely to have NAP1 strain than individuals <65 (P=.02). Residents of a nursing home prior to hospitalization were 10 times more likely to have NAP1 strain than patients residing in their homes (P=.001). More NAP1 cases had a change in treatment from metronidazole to oral vancomycin plus intravenous metronidazole (P=.01). The severity of CDI, incidence of mortality and recurrent CDI were similar between groups.

CONCLUSIONS

In a nonepidemic setting, NAP1 strains were more common in older patients and individuals admitted from nursing homes. Identification of NAP1 by PCR of stool specimens was associated in a change of therapy but did not predict worse outcomes. Reporting strain results may not be clinically useful in routine settings.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 3 , March 2015 , pp. 280 - 286
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presentation (in part): 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy; Denver, Colorado, USA; September 10–13, 2013 (Presentation Number: K-331)

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