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In the Endemic Setting, Clostridium difficile Ribotype 027 Is Virulent But Not Hypervirulent

Published online by Cambridge University Press:  20 August 2015

Samuel L. Aitken ,
M. Jahangir Alam ,
Mohammed Khaleduzzuman ,
Seth T. Walk ,
William L. Musick ,
Vy P. Pham ,
Jennifer L. Christensen ,
Robert L. Atmar ,
Yang Xie  and
Kevin W. Garey
Samuel L. Aitken
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
M. Jahangir Alam
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Mohammed Khaleduzzuman
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
Seth T. Walk
Affiliation:
Department of Microbiology and Immunology, Montana State University, Bozeman, Montana
William L. Musick
Affiliation:
Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
Vy P. Pham
Affiliation:
Department of Pharmacy, Memorial Hermann Northwest Hospital, Houston, Texas
Jennifer L. Christensen
Affiliation:
Department of Internal Medicine, Baylor College of Medicine Houston, Texas
Robert L. Atmar
Affiliation:
Department of Medicine, Section of Infectious Disease, Baylor College of Medicine Houston, Texas
Yang Xie
Affiliation:
Merck & Co., Whitehouse Station, New Jersey
Kevin W. Garey*
Affiliation:
Department of Pharmacy Practice and Translational Research, University of Houston College of Pharmacy, Houston, Texas
*
Address correspondence to Kevin W. Garey, PharmD, MS, Professor and Chair, University of Houston College of Pharmacy, 1441 Moursund St, Houston, TX 77030 (kgarey@uh.edu).
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Abstract

BACKGROUND

Conflicting reports have been published on the association between Clostridium difficile ribotypes and severe disease outcomes in patients with C. difficile infection (CDI); several so-called hypervirulent ribotypes have been described. We performed a multicenter study to assess severe disease presentation and severe outcomes among CDI patients infected with different ribotypes.

METHODS

Stool samples that tested positive for C. difficile toxin were collected and cultured from patients who presented to any of 7 different hospitals in Houston, Texas (2011–2013). C. difficile was characterized using a fluorescent PCR ribotyping method. Medical records were reviewed to determine clinical characteristics and ribotype association with severe CDI presentation (ie, leukocytosis and/or hypoalbuminemia) and severe CDI outcomes (ie, ICU admission, ileus, toxic megacolon, colectomy, and/or in-hospital death).

RESULTS

Our study included 715 patients aged 61±18 years (female: 63%; median Charlson comorbidity index: 2.5±2.4; hospital-onset CDI: 45%; severe CDI: 36.7%; severe CDI outcomes: 12.3%). The most common ribotypes were 027, 014-020, FP311, 002, 078-126, and 001. Ribotype 027 was a significant independent predictor of severe disease (adjusted odds ratio [aOR], 2.24; 95% confidence interval [CI], 1.53–3.29; P<.001) and severe CDI outcomes (aOR, 1.71; 95% CI, 1.02–2.85; P=.041) compared with all other ribotypes in aggregate. However, in an analysis using all common ribotypes as individual variables, ribotype 027 was not associated with severe CDI outcomes more often than other ribotypes.

CONCLUSION

Ribotype 027 showed virulence equal to that of other ribotypes identified in this endemic setting. Clinical severity markers of CDI may be more predictive of severe CDI outcomes than a particular ribotype.

Infect. Control Hosp. Epidemiol. 2015;36(11):1318–1323

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 11 , November 2015 , pp. 1318 - 1323
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

a

These authors contributed equally to this article.

b

Present affiliation: Division of Pharmacy, The University of Texas MD Anderson Cancer Center; Houston, Texas.

*

Author’s name has been corrected since original publication. An erratum notice detailing this change was also published (DOI 10.1017/ice.2015.305).

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