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Binary Toxin Expression by Clostridioides difficile Is Associated With Worse Disease.

Mary K Young1, Jhansi L Leslie1, Gregory R Madden1

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The presence of Clostridioides difficile binary toxin (CDT) in patients with C. difficile infection (CDI) is linked to more severe disease and higher mortality. Detecting CDT is valuable for identifying at-risk patients.

Keywords:
C. difficileCDICDTbinary toxinribotype 027

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Medicine

Background:

  • Clostridioides difficile infection (CDI) incidence has risen, posing an urgent public health threat.
  • Hypervirulent CDI strains, like ribotype 027, produce C. difficile binary toxin (CDT), increasing morbidity and mortality.

Purpose of the Study:

  • To investigate the correlation between CDT positivity in patients with CDI and disease severity.
  • To assess the impact of CDT on clinical outcomes, including mortality.
  • To examine the relationship between CDT and fecal microbiota composition in CDI patients.

Main Methods:

  • Retrospective analysis of stool samples from 215 CDI patients.
  • Enzyme-linked immunosorbent assay (ELISA) to detect CDT and quantitative PCR (qPCR) for the cdtB gene.
  • 16S rRNA gene sequencing to analyze fecal microbiota composition.

Main Results:

  • CDT-positive patients exhibited more severe CDI, higher 90-day mortality, increased C. difficile bacterial load, and elevated white blood cell counts.
  • No significant difference in gut microbiome diversity was observed between CDT-positive and CDT-negative patients.
  • ELISA detection of C. difficile binary toxin (CdtB) correlated with adverse clinical outcomes.

Conclusions:

  • Fecal CDT positivity in CDI patients is associated with increased disease severity and poorer clinical outcomes.
  • Standard diagnostic methods (PCR, toxins A/B testing) may not fully capture CDI severity.
  • Detecting CDT-expressing strains is crucial for identifying patients at higher risk for severe CDI.