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Ribotype 027 increases risk for severe C. difficile infection, mortality
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Age, concurrent antibiotic use and infection with ribotype 027 were associated with severe Clostridium difficile infection and mortality, according to researchers at the University of Michigan.
“The results provide evidence for an independent association between infection with ribotype 027 and both severe [Clostridium difficile infection] and 30-day, all-cause mortality in hospitalized patients in a nonepidemic setting,” Krishna Rao, MD, of the division of infectious diseases, University of Michigan School of Medicine, and colleagues wrote in Clinical Infectious Diseases.
The researchers assessed stool samples from 1,144 separate C. difficile cases in 981 patients hospitalized in the University of Michigan Health System. Among these cases, 37% had positive toxin A or B by enzyme immunoassay (EIA) tests; the other patients had positive tcdB tests, the researchers wrote. No cases were both glutamate dehydrogenase-negative and toxin-positive.
More than 35% of the cases were patients aged older than 65 years, 71% had symptom onset more than 48 hours after hospital admission, and 66% of patients were on concurrent non-C. difficile antibiotics.
“Several possible explanations exist for why older adults are at increased risk of adverse outcomes from [C. difficile infection]: immunosenescence and decreased responsiveness to neoantigens, including toxins A and B; decreased colonization resistance with fewer competing anaerobes in the microbiome; and greater exposure to risk factors for CDI such as health care settings and antimicrobials,” the researchers wrote.
Rao and colleagues identified 137 distinct C. difficile ribotypes. The most common were isolates of ribotype 014-020 (16.2%) and ribotype 027 (16.2%).
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