Epidemiology and Infection

Original Papers

Gastroenteritis/Food poisoning

Characteristics of patients with Clostridium difficile infection in Taiwan

Y.-C. LINa1a2, Y.-T. HUANGa3, T.-F. LEEa4, N.-Y. LEEa5, C.-H. LIAOa6, S.-Y. LINa1a2, W.-C. KOa5 and P.-R. HSUEHa3a4 c1

a1 Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan

a2 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

a3 Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

a4 Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan

a5 Departments of Internal Medicine and Center for Infection Control, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan

a6 Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan

SUMMARY

The medical records of 84 patients with stool cultures positive for Clostridium difficile during the period August 2007 to June 2009 were retrospectively reviewed. A case of confirmed (toxigenic) C. difficile infection (CDI) was defined by the presence of symptoms (fever, diarrhoea, abdominal discomfort or distension, ileus) and the presence of toxigenic C. difficile. Patients with compatible clinical symptoms and stool cultures positive for non-toxigenic C. difficile isolates were defined as probable (non-toxigenic) CDI cases. Of these 84 patients, 50 (59·5%) were diagnosed as confirmed CDI and 34 (40·5%) as probable CDI. Thirteen (15·5%) of the 84 patients died during their hospital stay. Usage of proton pump inhibitors was a significant independent risk factor for CDI (OR 3·21, P = 0·014). Of the 50 isolates associated with confirmed CDI, seven (8·3%) carried binary toxin genes (cdtAB), and six (7·1%) had a deletion in the tcdC gene. The mortality rate in confirmed CDI patients with isolates exhibiting deletion in the tcdC gene (2/6, 33·3%), those with isolates harbouring binary toxin genes (2/7, 28·6%), and those with isolates containing mutations in gyrA (2/7, 28·6%) and gyrB (1/2, 50%) was higher than the overall mortality rate (10/50, 20%) in patients with confirmed CDI.

(Received December 14 2011)

(Revised October 01 2012)

(Accepted November 12 2012)

(Online publication December 06 2012)

Key words

  • Clostridium difficile infection;
  • clinical characteristics;
  • outcome;
  • Taiwan;
  • toxin genes

Correspondence

c1 Author for correspondence: Dr P. R. Hsueh, Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan. (Email: hsporen@ntu.edu.tw)

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