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Clostridium difficile recurrences in Stockholm.

Staffan Sandell1, Mamun-Ur Rashid2, Christina Jorup-Rönström1

  • 1Karolinska Institutet, Department of Medicine, Division of Infectious Diseases, Södersjukhuset, SE-118 83 Stockholm, Sweden.

Anaerobe
|January 24, 2016
PubMed
Summary

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Recurrent Clostridium difficile infection (CDI) affects over half of patients, with specific strains like 078/126 and 023 being more prone to recurrence. Older age and comorbidities are linked to higher recurrence and fatality rates.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Epidemiology

Background:

  • Clostridium difficile infection (CDI) is a significant cause of hospital-acquired diarrhea.
  • Understanding recurrence patterns and associated risk factors is crucial for patient management.

Purpose of the Study:

  • To investigate the microbiological and clinical recurrence of CDI in hospitalized patients.
  • To identify risk factors, prevalent C. difficile strains, and their characteristics associated with recurrence.

Main Methods:

  • Prospective follow-up of 68 patients with a first CDI episode over 1 year.
  • Analysis of fecal samples for C. difficile toxins and genes (toxin A, B, binary toxin, TcdC deletion) using PCR.
  • PCR-ribotyping of isolates and determination of antimicrobial susceptibility (MICs).
Keywords:
Antibiotic treatmentClinical recurrenceClostridium difficile infectionMicrobiological recurrenceMinimum inhibitory concentrationRibotyping

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  • Evaluation of antibiotic history, clinical signs, comorbidities, and recurrence data.

    • Main Results:

    • 57% of 56 evaluable patients experienced recurrence (microbiological or clinical).
    • 16 patients (23%) had microbiologically confirmed clinical recurrences.
    • Commonly identified ribotypes included 078/126, 020, 023, 026, 014/077, 001, and 005; ribotype 027 was absent.
    • Ribotypes 078/126 and 023, positive for binary toxin, were most associated with recurrence.
    • All strains were susceptible to vancomycin and metronidazole.
    • Older age (p=0.02) and high comorbidity burden were associated with recurrence and a high fatality rate (38% died within 1 year).

    Conclusions:

    • Recurrence of CDI is common, with relapse and reinfection playing significant roles.
    • Specific C. difficile strains carrying binary toxin genes are linked to increased recurrence.
    • Patient age and comorbidities are critical factors influencing CDI recurrence and outcomes.