Predicting Recurrence of C. difficile Colitis Using Bacterial Virulence Factors: Binary Toxin Is the Key

Background Recurrent Clostridium difficile colitis is common, yet the ability to predict recurrence is poorly developed. Methods Patients ≥18 years of age treated at our institution for C. difficile of any severity were consecutively enrolled. C. difficile colitis was defined as symptoms of colitis...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2013, Vol.17 (1), p.118-125
Main Authors: Stewart, David B., Berg, Arthur, Hegarty, John
Format: Article
Language:English
Subjects:
2012 SSAT Plenary Presentation
ADP Ribose Transferases - genetics
Aged
Bacterial Proteins - genetics
Bacterial Toxins - genetics
Clostridioides difficile - genetics
Clostridioides difficile - isolation & purification
Clostridioides difficile - pathogenicity
Clostridium Infections - diagnosis
Clostridium Infections - microbiology
Colitis - diagnosis
Colitis - microbiology
DNA, Bacterial
Enterotoxins - genetics
Female
Gastroenterology
Genetic Markers
Humans
Linear Models
Logistic Models
Male
Medicine
Medicine & Public Health
Middle Aged
Multivariate Analysis
Recurrence
Repressor Proteins - genetics
Ribotyping
Surgery
Virulence Factors - genetics
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Summary:Background Recurrent Clostridium difficile colitis is common, yet the ability to predict recurrence is poorly developed. Methods Patients ≥18 years of age treated at our institution for C. difficile of any severity were consecutively enrolled. C. difficile colitis was defined as symptoms of colitis with a positive PCR stool test. Each bacterial isolate was studied for virulence factors: tcdC mutations via PCR; the presence of genes for toxins A, B, and binary toxin using restriction fragment length polymorphism; and identification of ribotype 027 by PCR. Chi-squared tests, t tests, and logistic and linear regression were used to determine which virulence factors predicted recurrence. Results Sixty-nine patients (male, 57 %) were studied, with a mean age of 64 ± 13 years. Twenty-one (30 %) patients were initially diagnosed as outpatients. There was no difference ( p  > 0.05) between virulence factors among inpatients and outpatients. The presence of a binary toxin gene was the single virulence factor independently associated with recurrence ( p  = 0.02). The combination of a tcdC mutation with binary toxin gene resulted in the highest odds of recurrence (OR, 5.3; 95 % CI, 3.52–6.09). Conclusion Binary toxin gene is a predictor of recurrent infection. Its presence may require longer antibiotic regimens in an effort to lower already elevated recurrence rates.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-012-2056-6