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Clinical Characteristics and Treatment Outcomes of Clostridium difficile Infections by PCR Ribotype 017 and 018 Strains

Title
Clinical Characteristics and Treatment Outcomes of Clostridium difficile Infections by PCR Ribotype 017 and 018 Strains
Author
김지은
Keywords
TOXIN-B; INCREASED SPORULATION; RISK-FACTORS; EPIDEMIOLOGY; JAPAN; EMERGENCE; RESISTANT; AMERICA; KOREA
Issue Date
2016-12
Publisher
PUBLIC LIBRARY SCIENCE
Citation
PLOS ONE, v. 11, NO 12, Page. e0168849
Abstract
The objective of this study was to identify the clinical characteristics of Clostridium difficile infections (CDIs) caused by toxin A-negative/toxin B-positive (A-B+) PCR ribotype 017 (R017) and A+B+ ribotype 018 (R018) strains, prevalent in Asian countries. From February 2010 through January 2013, all CDI patients in our hospital were enrolled; their medical records were retrospectively reviewed, and the isolates were characterized by toxigenic culture and PCR ribotyping. Based on the ribotypes, a total of 510 cases were categorized as R017 (139, 27.3%), R018 (157, 30.8%) and other ribotypes groups (214, 42.0%), and clinical variables were compared between R017 and other ribotypes, R018 and other ribotypes and R018 and R017 groups. The patients with R017 infections had a higher mean Charlson's comorbidity index (OR 1.1, 1-1.21, p = 0.05), lower serum albumin (OR 0.47, 0.31-0.73, p = 0.001) and lower CRP levels (OR 0.96, 0.92-0.99, p = 0.022) than those with other ribotypes. R018 infections caused more azotemia (OR 4.06, 1.28-12.91, p = 0.018) and more frequent severe CDI (OR 1.87, 1.12-3.13, p = 0.016) than the other ribotypes infections. R017 and R018 infections were more often associated with toxin positive stools (OR 2.94, 1.65-4.09, p<0.001; OR 4.55, 2.82-7.33, p<0.001). In terms of treatment outcomes, R017 infections caused a marginally higher 30-day mortality than other ribotypes infection. In a final multiple logistic regression model, 30-day mortality was associated with leukocytosis (OR 2.45, 1.0-6.01, p = 0.05) and hypoalbuminemia (OR 4.57, 1.83-11.39, p = 0.001), but only marginally with R017 infection (OR 2.14, 0.88-5.22, p = 0.094). In conclusion, infections by C. difficile R018 strains tend to cause more severe disease, while there was a trend for higher mortality with R017 infections.
URI
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168849https://repository.hanyang.ac.kr/handle/20.500.11754/101754
ISSN
1932-6203
DOI
10.1371/journal.pone.0168849
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COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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