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Clostridium difficileInfection (CDI) Severity and Outcome among Patients Infected with the NAP1/BI/027 Strain in a Non-Epidemic Setting

Published online by Cambridge University Press:  22 December 2014

T. Scardina ,
L. Labuszewski ,
S.M. Pacheco ,
W. Adams ,
P. Schreckenberger  and
S. Johnson
T. Scardina*
Affiliation:
Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
L. Labuszewski
Affiliation:
Department of Pharmacy, Loyola University Medical Center, Maywood, Illinois, USA
S.M. Pacheco
Affiliation:
Edward Hines Jr. VA Hospital, Hines, Illinois, USA Department of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois, USA
W. Adams
Affiliation:
Loyola University Chicago, Chicago, Illinois, USA
P. Schreckenberger
Affiliation:
Department of Pathology, Loyola University Medical Center, Maywood, Illinois, USA
S. Johnson
Affiliation:
Edward Hines Jr. VA Hospital, Hines, Illinois, USA Department of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois, USA
*
Address correspondence to Tonya Scardina, PharmD, 2160 South First Avenue, Maywood, Illinois 60153 (tscardina@lumc.edu).
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Abstract

OBJECTIVE

Determine whether the NAP1 strain identified by polymerase chain reaction (PCR)-based stool assay is correlated with CDI severity and clinical outcomes.

METHODS

Medical records of adult patients with positive stool Xpert® Clostridium difficile PCR assay for an initial episode of CDI between January 2012 and January 2013 at a tertiary care hospital in Chicago were reviewed. Two patients diagnosed with CDI caused by a non-NAP1 strain (positive Xpert® C. difficile assay but negative Xpert® C. difficile Epi assay) were included for each patient diagnosed with CDI caused by a NAP1 strain (positive Epi assay). Patient charts were reviewed for markers of severity, risk factors, treatment regimens, and outcomes.

RESULTS

Of 494 stool specimens, 90 (18%) that were positive for C. difficile by PCR were positive for NAP1 strain. In total, 37 patients with CDI due to NAP1 were matched with 74 patients with CDI due to non-NAP1 strains. Multivariable model revealed individuals ≥65 years old were 3 times more likely to have NAP1 strain than individuals <65 (P=.02). Residents of a nursing home prior to hospitalization were 10 times more likely to have NAP1 strain than patients residing in their homes (P=.001). More NAP1 cases had a change in treatment from metronidazole to oral vancomycin plus intravenous metronidazole (P=.01). The severity of CDI, incidence of mortality and recurrent CDI were similar between groups.

CONCLUSIONS

In a nonepidemic setting, NAP1 strains were more common in older patients and individuals admitted from nursing homes. Identification of NAP1 by PCR of stool specimens was associated in a change of therapy but did not predict worse outcomes. Reporting strain results may not be clinically useful in routine settings.

Infect Control Hosp Epidemiol 2014;00(0): 1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 3 , March 2015 , pp. 280 - 286
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Presentation (in part): 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy; Denver, Colorado, USA; September 10–13, 2013 (Presentation Number: K-331)

References

REFERENCES

1.McDonald, LC, Killgore, GE, Thompson, A, et al.An epidemic, toxin gene-variant strain of Clostridium difficile. N Engl J Med 2005;353:2433–2441.CrossRefGoogle ScholarPubMed
2.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.CrossRefGoogle ScholarPubMed
3.O’Connor, JR, Johnson, S, Gerding, DN. Clostridium difficle infection caused by the epidemic BI/NAP1/027 strain. Gastroenterology 2009;136:1913–1924.CrossRefGoogle Scholar
4.Vardakas, KZ, Konstantelias, AA, Loizidis, G, Rafailidis, PI, Falagas, ME. Risk factors for development of Clostridium difficile infection due to BI/NAP1/027 strain: a meta-analysis. Int J Infect Dis 2012;16:e768–e773.CrossRefGoogle ScholarPubMed
5.Miller, M, Gravel, Mulvey, M, et al.Health care-associated Clostridium difficile infection in Canada: patient age and infecting strain type are highly predictive of severe outcome and mortality. Clin Infect Dis 2010;50:194–201.CrossRefGoogle ScholarPubMed
6.Walker, AS, Eyre, DW, Wyllie, DH, et al.Relationship between bacterial strain type, host biomarkers, and mortality in Clostridium difficile infection. Clin Infect Dis 2013;56:1589–1600.CrossRefGoogle ScholarPubMed
7.See, I, Mu, Y, Cohen, J, et al.NAP1 Strain type predicts outcomes from Clostridium difficile infection. Clin Infect Dis 2014.CrossRefGoogle ScholarPubMed
8.Cohen, SH, Gerding, DN, Johnson, S, et al.Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.CrossRefGoogle Scholar
9.Zar, FA, Bakkanagari, SR, Moorthi, KM, et al.A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis 2007;45:302–307.CrossRefGoogle ScholarPubMed
10.Debast, SB, Vaessen, N, Choudry, A, Wiegers-Ligtvoet, EAJ, van den Berg, RJ, Kuijper, EJ. Successful combat of an outbreak due to Clostridium difficile PCR ribotype 027 and recognition of specific risk factors. Clin Microbiol Infect 2009;15:427–434.CrossRefGoogle ScholarPubMed
11.Goorhuis, A, Debast, SB, Dutilh, JC, et al.Type-specific risk factors and outcome in an outbreak with 2 different Clostridium difficile types simultaneously in 1 hospital. Clin Infect Dis 2011;53:860–869.CrossRefGoogle Scholar
12.Cloud, J, Noddin, L, Pressman, A, Hu, M, Kelly, C. Clostridium difficile strain NAP-1 is not associated with severe disease in a non-epidemic setting. Clin Gastroenterol Hepatol 2009;7:868–873.CrossRefGoogle ScholarPubMed
13.Wilson, V, Cheek, L, Satta, G, et al.Predicators of death after Clostridium difficile infection: a report on 128 strain-typed cases from a teaching hospital in the United Kingdom. Clin Infect Dis 2010;50:e77–e81.CrossRefGoogle Scholar
14.Limbago, BM, Long, CM, Thompson, AD, et al.Clostridium difficile strains from community-associated infections. J Clin Microbiol 2009;47:3004–3007.CrossRefGoogle ScholarPubMed
15.Black, SR, Weaver, KN, Jones, RC, et al.Clostridium difficile outbreak strain BI is highly endemic in Chicago area hospitals. Infect Control Hosp Epidemiol 2011;32:897–902.CrossRefGoogle ScholarPubMed
16.Labbé, AC, Poirier, L, MacCannell, D, et al.Clostridium difficile infections in a Canadian tertiary care hospital before and during a regional epidemic associated with the BI/NAP/027 strain. Antimicrob Agents Chemother 2008;52:3180–3187.CrossRefGoogle Scholar
17.Riggs, MM, Sethi, AK, Zabarsky, TF, Eckstein, EC, Jump, RL, Donskey, CJ. Asymptomatic carriers are a potential source for transmission of epidemic and non-epidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007;45:992–998.CrossRefGoogle Scholar
18.Morgan, OW, Rodrigues, B, Elston, T, et al.Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study. PLoS ONE 2008;3(3):e1812.CrossRefGoogle ScholarPubMed
19.Belmares, J, Gerding, DN, Tillotson, G, Johnson, S. Measuring the severity of Clostridium difficile infection: implications for management and drug development. Expert Rev Anti Infect Ther 2008;6:897–908.CrossRefGoogle ScholarPubMed
20.Boone, JH, Goodykoontz, M, Rhodes, SJ, et al.Clostridium difficile prevalence rates in a large healthcare system stratified according to patient population, age, gender, and specimen consistency. Eur J Clin Microbiol Infect Dis 2012;31:1551–1559.CrossRefGoogle Scholar
21.Sirard, S, Valiquette, L, Fortier, LC. Lack of association between clinical outcome of Clostridium difficile infections, strain type, and virulence-associated phenotypes. J Clin Microbiol 2011;49:4040–4046.CrossRefGoogle ScholarPubMed
22.Petrella, LA, Sambol, SP, Cheknis, A, et al.Decreased cure and increased recurrence rates for Clostridium difficile infection caused by the epidemic C. difficile BI strain. Clin Infect Dis 2012;55:351–357.CrossRefGoogle ScholarPubMed
23.Marsh, JW, Arora, R, Schlackman, JL, Shutt, KA, Curry, SR, Harrison, LH. Association of relapse of Clostridium difficile disease with BI/NAP1/027. J Clin Microbiol 2012;50:4078–4082.CrossRefGoogle ScholarPubMed
24.Walk, ST, Micic, D, Jain, R, et al.Clostridium difficile ribotype does not predict severe infection. Clin Infect Dis 2012;55:1661–1668.CrossRefGoogle Scholar
25.Abou Chakra, CN, Pepin, J, Sirard, S, Valiquette, L. Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review. PLoS One 2014;9:e98400.CrossRefGoogle ScholarPubMed