Clinical outcomes of Clostridium difficile infection according to strain type. A prospective study in medical wards.

Abstract

OBJECTIVES:

To describe clinical characteristics and outcome of Clostridium difficile infection (CDI) patients in Internal Medicine, to identify ribotypes (RTs); to evaluate the association between RT and patient clinical characteristics and report outcome.

METHODS:

One year prospective cohort study. Clinical data, Barthel Index (BI) and outcomes were collected for all inpatients suffering from CDI (n = 148) in hospital wards in Northern Italy. 84 fecal samples were analysed for molecular typing.

RESULTS:

12 RTs were identified, predominantly RT018 (42.9%, n = 36/84) and RT356/607 (40.5%, n = 34/84). Patients with dementia were more frequent among those infected by RT018 [55.6% (n = 20/36) vs. 32.4% (n = 11/34), p = 0.05]. The median BI score of patients with RT018 was lower than BI score of patients with RT356/607 [10 (IQR 0-32) vs. 15 (IQR 5-50), p = 0.06]. RT018 infection was associated to higher levels of C-reactive protein [7.2 mg/dl (IQR 4.1-14.7) vs. 4.0 mg/dl (IQR 2.2-6.8), p = 0.01] and white blood cells ≥15,000/dl [33.3% (n = 12/36) vs. 14.7% (n = 5/34) of patients, p = 0.07]. Higher mortality was noted among RT018 infected patients. We found a continuous mortality increase according to the ATLAS score.

CONCLUSIONS:

Our results confirm that RT018 and RT356/607 are the two major RTs causing CDI in older patients with a high degree of disability in Northern Italy and RT018 is associated with more serious outcomes.

• Authors: S Serafino, D Consonni, M Migone De Amicis, F Sisto, G Domeniconi, S Formica, M Zarantonello, A Maraschini, M D Cappellini, P Spigaglia, F Barbanti, S Castaldi, G Fabio
• Journal: European journal of internal medicine (Eur J Intern Med) Vol. 54 Pg. 21-26 (08 2018) ISSN: 1879-0828 [Electronic] Netherlands
• PMID: 29650357 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2018. Published by Elsevier B.V.

Chemical References

• Anti-Bacterial Agents

Topics

• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents (therapeutic use)
• Clostridioides difficile (classification, isolation & purification)
• Clostridium Infections (drug therapy, mortality)
• Cross Infection
• Feces (microbiology)
• Female
• Humans
• Italy
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Multivariate Analysis
• Polymerase Chain Reaction
• Proportional Hazards Models
• Prospective Studies
• Ribotyping
• Severity of Illness Index