Related Experiment Video
Updated: Jul 15, 2025
A Protocol to Characterize the Morphological Changes of Clostridium difficile in Response to Antibiotic Treatment
Published on: May 25, 2017
CLINICAL OUTCOME AND SEVERITY OF CLOSTRIDIOIDES (CLOSTRIDIUM) DIFFICILE INFECTION AT A TERTIARY REFERRAL HOSPITAL IN
Fernando Antônio Castro Carvalho1, Rodrigo Otávio Silveira Silva2, Bárbara Moreira Ribeiro Trindade Dos Santos1
1Hospital de Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.
Insights
Clostridioides difficile infection (CDI) outcomes in Brazil showed lack of clinical improvement and high ATLAS scores increased mortality risk. High comorbidity index predicted recurrence, while multiple antibiotics prolonged hospital stays in CDI patients.
Area of Science:
- Infectious Diseases
- Epidemiology
- Clinical Microbiology
Background:
- Clostridioides difficile infection (CDI) is a severe gastrointestinal disease with potential for refractoriness, recurrence, and mortality.
- Brazilian CDI epidemiology may differ from other regions, with a high prevalence of RT106 and limited RT027 cases.
- Understanding CDI outcomes and associated factors is crucial for effective patient management.
Purpose of the Study:
- To evaluate the clinical outcomes of Clostridioides difficile infection (CDI) in a Brazilian tertiary hospital.
- To identify risk factors associated with mortality, prolonged hospitalization, and recurrence in CDI patients.
- To explore the association between CDI outcomes and bacterial ribotypes.
Main Methods:
- A cohort of 65 patients diagnosed with CDI was analyzed.
- Stool samples underwent A/B toxin detection and toxigenic culture.
- PCR ribotyping was performed on 44 toxigenic isolates to identify C. difficile strains.
Main Results:
- Mortality was 24.6%, associated with lack of clinical improvement and high ATLAS scores.
- Longer hospital stays correlated with enteral nutrition and multiple antimicrobial agents.
- Recurrence was linked to a Charlson Comorbidity Index (CCI) greater than 7.
- Twenty ribotypes were identified, with RT106 being the most prevalent (43.2%), but no association with outcomes was found.
Conclusions:
- Key risk factors for increased mortality, extended hospital stays, and CDI recurrence were identified.
- A diverse range of C. difficile ribotypes was observed in the Brazilian cohort.
- No direct relationship was established between specific ribotypes and patient outcomes in this study.
Abstract:
•The outcomes of CDI were evaluated in 65 patients with CDI in a Brazilian tertiary hospital. •Lack of clinical improvement after treatment and the severity score (ATLAS) increased the risk of death. •The use of multiple antimicrobial agents was associated with longer hospital stays. •Patients with high Charlson comorbidity index (>7) were more likely to recur. Background - Clostridioides difficile infection (CDI) is a potentially severe disease that can present with refractoriness, recurrence, and evolution to death. In Brazil, the epidemiology of CDI seems to differ from that of the United States and most European countries, with only one ribotype (RT) 027-related case and a high prevalence of RT106. Objective - The aim of this study was to evaluate the outcomes of CDI and its possible association with ribotypes at a university hospital in Brazil. Methods - A total of 65 patients with CDI were included and stool samples were submitted to A/B toxin detection and toxigenic culture, and toxigenic isolates (n=44) were also PCR ribotyped. Results - Patients' median age was 59 (20-87) years and there were 16 (24.6%) deaths. The median Charlson comorbidity index (CCI) was 4 (0-15) and 16.9% of the patients had CCI ≥8. The ATLAS score and non-improvement of diarrhea were related to higher mortality. A longer length of hospitalization was related to the enteral nutrition and use of multiple antibiotics. The period between CDI diagnosis and hospital discharge was longer in those who received new antibiotics after diagnosis, multiple antibiotics, and required intensive care treatment. Recurrence was associated with CCI >7. Twenty ribotypes were identified and RT106 was the most frequently detected strain (43.2%). No relationship was observed between the ribotypes and outcomes. CDI was present in patients with more comorbidities. Conclusion - Risk factors for higher mortality, longer hospital stay and recurrence were identified. A diversity of ribotypes was observed and C. difficile strains were not related to the outcomes.
Related Concept Videos
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies.
01:30Pneumonia III: Complications and Assessment
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:30Irritable Bowel Syndrome II: Clinical Features and Diagnostic Evaluation
Irritable Bowel Syndrome (IBS) is classified into subtypes based on the predominant bowel habits as determined by the Bristol Stool Form Scale (BSFS). The subtypes are: