Surveillance of infection severity: a registry study of laboratory diagnosed Clostridium difficile

Changing clinical impact, as virulent clones replace less virulent ones, is a feature of many pathogenic bacterial species and can be difficult to detect. Consequently, innovative techniques monitoring infection severity are of potential clinical value. We studied 5,551 toxin-positive and 20,098 per...

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Bibliographic Details
Published in:PLoS medicine 2012-07, Vol.9 (7), p.e1001279-e1001279
Main Authors: Schlackow, Iryna, Walker, A Sarah, Dingle, Kate, Griffiths, David, Oakley, Sarah, Finney, John, Vaughan, Ali, Gill, Martin J, Crook, Derrick W, Peto, Tim E A, Wyllie, David H
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Analysis
Bacterial infections
Biology
Biomarkers
Biomedical research
Blood
Clostridioides difficile - pathogenicity
Clostridioides difficile - physiology
Clostridium difficile
Clostridium Infections - diagnosis
Clostridium Infections - epidemiology
Clostridium Infections - mortality
Computer Simulation
Control
Demography
Female
Genetic diversity
Hospitals
Humans
Incidence
Laboratories, Hospital - statistics & numerical data
Male
Medical case management
Medical research
Methods
Models, Biological
Mortality
Neutrophils - pathology
Population Surveillance
Registries - statistics & numerical data
Regression Analysis
Reproducibility of Results
Retrospective Studies
Severity of Illness Index
Studies
Technology application
United Kingdom
United Kingdom - epidemiology
Virulence
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Summary:Changing clinical impact, as virulent clones replace less virulent ones, is a feature of many pathogenic bacterial species and can be difficult to detect. Consequently, innovative techniques monitoring infection severity are of potential clinical value. We studied 5,551 toxin-positive and 20,098 persistently toxin-negative patients tested for Clostridium difficile infection between February 1998 and July 2009 in a group of hospitals based in Oxford, UK, and investigated 28-day mortality and biomarkers of inflammation (blood neutrophil count, urea, and creatinine concentrations) collected at diagnosis using iterative sequential regression (ISR), a novel joinpoint-based regression technique suitable for serial monitoring of continuous or dichotomous outcomes. Among C. difficile toxin-positive patients in the Oxford hospitals, mean neutrophil counts on diagnosis increased from 2003, peaked in 2006-2007, and then declined; 28-day mortality increased from early 2006, peaked in late 2006-2007, and then declined. Molecular typing confirmed these changes were likely due to the ingress of the globally distributed severe C. difficile strain, ST1. We assessed the generalizability of ISR-based severity monitoring in three ways. First, we assessed and found strong (p
ISSN:1549-1676
1549-1277
1549-1676
DOI:10.1371/journal.pmed.1001279