Binary toxin and death after Clostridium difficile infection

We compared 30-day case-fatality rates for patients infected with Clostridium difficile possessing genes for toxins A and B without binary toxin (n = 212) with rates for patients infected with C. difficile possessing genes for A, B, and binary toxin. The latter group comprised patients infected with...

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Bibliographic Details
Published in:Emerging infectious diseases 2011-06, Vol.17 (6), p.976-982
Main Authors: Bacci, Sabrina, Mølbak, Kåre, Kjeldsen, Marianne K, Olsen, Katharina E P
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
bacteria
Bacterial Proteins - genetics
Bacterial Proteins - metabolism
Bacterial toxins
Bacterial Toxins - genetics
Bacterial Toxins - metabolism
binary toxin
Clostridioides difficile - pathogenicity
Clostridioides difficile - physiology
Clostridium difficile
Clostridium Infections - metabolism
Clostridium Infections - microbiology
Clostridium Infections - mortality
Denmark
Enterotoxins - genetics
Enterotoxins - metabolism
Europe
Female
Genetic aspects
Humans
Kaplan-Meier Estimate
Male
Methods
Middle Aged
mortality
Polymerase chain reaction
Properties
Risk
Time Factors
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Summary:We compared 30-day case-fatality rates for patients infected with Clostridium difficile possessing genes for toxins A and B without binary toxin (n = 212) with rates for patients infected with C. difficile possessing genes for A, B, and binary toxin. The latter group comprised patients infected with strains of PCR ribotype 027 (CD027, n = 193) or non-027 (CD non-027, n = 72). Patients with binary toxin had higher case-fatality rates than patients without binary toxin, in univariate analysis (relative risk [RR] 1.8, 95% confidence interval [CI] 1.2-2.7) and multivariate analysis after adjustment for age, sex, and geographic region (RR 1.6, 95% CI 1.0-2.4). Similar case-fatality rates (27.8%, 28.0%) were observed for patients infected with CD027 or CD non-027. Binary toxin either is a marker for more virulent C. difficile strains or contributes directly to strain virulence. Efforts to control C. difficile infection should target all virulent strains irrespective of PCR ribotype.
ISSN:1080-6040
1080-6059
DOI:10.3201/eid1706.101483