Clostridium difficile ribotype does not predict severe infection

Seth T. Walk; Dejan Micic; Ruchika Jain; Eugene S. Lo; Itishree Trivedi; Eugene W. Liu; Luay M. Almassalha; Sarah A. Ewing; Cathrin Ring; Andrzej T. Galecki; Mary A.M. Rogers; Laraine Washer; Duane W. Newton; Preeti N. Malani; Vincent B. Young; David M. Aronoff

doi:10.1093/cid/cis786

Clostridium difficile ribotype does not predict severe infection

Seth T. Walk, Dejan Micic, Ruchika Jain, Eugene S. Lo, Itishree Trivedi, Eugene W. Liu, Luay M. Almassalha, Sarah A. Ewing, Cathrin Ring, Andrzej T. Galecki, Mary A.M. Rogers, Laraine Washer, Duane W. Newton, Preeti N. Malani, Vincent B. Young, David M. Aronoff

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166 Scopus citations

Abstract

Background. Studies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cause more severe disease than other ribotypes. A growing number of studies challenge the validity of this hypothesis.Methods. We conducted a cross-sectional study of C. difficile infection (CDI) to test whether ribotype predicted clinical severity when adjusted for the influence of other predictors. Toxigenic C. difficile isolates were cultured from stool samples, screened for genes encoding virulence factors by polymerase chain reaction (PCR) and ribotyped using high-throughput, fluorescent PCR ribotyping. We collected data for 15 covariates (microbiologic, epidemiologic, and laboratory variables) and determined their individual and cumulative influence on the association between C. difficile ribotype and severe disease. We then validated this influence using an independent data set.Results. A total of 34 severe CDI cases were identified among 310 independent cases of disease (11.0%). Eleven covariates, including C. difficile ribotype, were significant predictors of severe CDI in unadjusted analysis. However, the association between ribotypes 027 and 078 and severe CDI was not significant after adjustment for any of the other covariates. After full adjustment, severe cases were significantly predicted only by patients' white blood cell count and albumin level. This result was supported by analysis of a validation data set containing 433 independent CDI cases (45 severe cases; 10.4%).Conclusions. Ribotype is not a significant predictor of severe CDI when adjusted for the influence of any other variables separately or in combination. White blood cell count and albumin level are the most clinically relevant predictors of severe CDI cases.

Original language	English (US)
Pages (from-to)	1661-1668
Number of pages	8
Journal	Clinical Infectious Diseases
Volume	55
Issue number	12
DOIs	https://doi.org/10.1093/cid/cis786
State	Published - Dec 15 2012
Externally published	Yes

ASJC Scopus subject areas

Microbiology (medical)
Infectious Diseases

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Walk, S. T., Micic, D., Jain, R., Lo, E. S., Trivedi, I., Liu, E. W., Almassalha, L. M., Ewing, S. A., Ring, C., Galecki, A. T., Rogers, M. A. M., Washer, L., Newton, D. W., Malani, P. N., Young, V. B., & Aronoff, D. M. (2012). Clostridium difficile ribotype does not predict severe infection. Clinical Infectious Diseases, 55(12), 1661-1668. https://doi.org/10.1093/cid/cis786

@article{aa1999a7c14d4f81a0495ff041510e44,

title = "Clostridium difficile ribotype does not predict severe infection",

abstract = "Background. Studies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cause more severe disease than other ribotypes. A growing number of studies challenge the validity of this hypothesis.Methods. We conducted a cross-sectional study of C. difficile infection (CDI) to test whether ribotype predicted clinical severity when adjusted for the influence of other predictors. Toxigenic C. difficile isolates were cultured from stool samples, screened for genes encoding virulence factors by polymerase chain reaction (PCR) and ribotyped using high-throughput, fluorescent PCR ribotyping. We collected data for 15 covariates (microbiologic, epidemiologic, and laboratory variables) and determined their individual and cumulative influence on the association between C. difficile ribotype and severe disease. We then validated this influence using an independent data set.Results. A total of 34 severe CDI cases were identified among 310 independent cases of disease (11.0%). Eleven covariates, including C. difficile ribotype, were significant predictors of severe CDI in unadjusted analysis. However, the association between ribotypes 027 and 078 and severe CDI was not significant after adjustment for any of the other covariates. After full adjustment, severe cases were significantly predicted only by patients' white blood cell count and albumin level. This result was supported by analysis of a validation data set containing 433 independent CDI cases (45 severe cases; 10.4%).Conclusions. Ribotype is not a significant predictor of severe CDI when adjusted for the influence of any other variables separately or in combination. White blood cell count and albumin level are the most clinically relevant predictors of severe CDI cases.",

author = "Walk, {Seth T.} and Dejan Micic and Ruchika Jain and Lo, {Eugene S.} and Itishree Trivedi and Liu, {Eugene W.} and Almassalha, {Luay M.} and Ewing, {Sarah A.} and Cathrin Ring and Galecki, {Andrzej T.} and Rogers, {Mary A.M.} and Laraine Washer and Newton, {Duane W.} and Malani, {Preeti N.} and Young, {Vincent B.} and Aronoff, {David M.}",

note = "Funding Information: Financial support. This work was supported by Award number UL1RR024986 from the National Center for Research Resources (S. T. W. and D. M. A.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. Additional support came from the National Institutes of Health grant 1U19AI090871–01 (S. T. W., L. W, V. B. Y., and D. M. A), 1K01AI09728101A1 (S. T. W.), and the Department of Veterans Affairs and Geriatric Research Education and Clinical Center (P. N. M). We also gratefully acknowledge support from the Claude Pepper Center grants AG08808 and AG024824 from the National Institute of Aging. S. E. received grant support from the American Society for Microbiology and institutional grant support from Enterics Research Investigational Network. R. J. received grant support from the National Institutes of Health (National Center for Research Resources, National Institute of Aging). M. R. received institutional grant support from the National Institutes of Health (National Center for Research Resources, National Institute of Aging). Potential conflicts of interest. All authors: No reported conflicts.",

year = "2012",

month = dec,

day = "15",

doi = "10.1093/cid/cis786",

language = "English (US)",

volume = "55",

pages = "1661--1668",

journal = "Clinical Infectious Diseases",

issn = "1058-4838",

publisher = "Oxford University Press",

number = "12",

}

TY - JOUR

T1 - Clostridium difficile ribotype does not predict severe infection

AU - Walk, Seth T.

AU - Micic, Dejan

AU - Jain, Ruchika

AU - Lo, Eugene S.

AU - Trivedi, Itishree

AU - Liu, Eugene W.

AU - Almassalha, Luay M.

AU - Ewing, Sarah A.

AU - Ring, Cathrin

AU - Galecki, Andrzej T.

AU - Rogers, Mary A.M.

AU - Washer, Laraine

AU - Newton, Duane W.

AU - Malani, Preeti N.

AU - Young, Vincent B.

AU - Aronoff, David M.

N1 - Funding Information: Financial support. This work was supported by Award number UL1RR024986 from the National Center for Research Resources (S. T. W. and D. M. A.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. Additional support came from the National Institutes of Health grant 1U19AI090871–01 (S. T. W., L. W, V. B. Y., and D. M. A), 1K01AI09728101A1 (S. T. W.), and the Department of Veterans Affairs and Geriatric Research Education and Clinical Center (P. N. M). We also gratefully acknowledge support from the Claude Pepper Center grants AG08808 and AG024824 from the National Institute of Aging. S. E. received grant support from the American Society for Microbiology and institutional grant support from Enterics Research Investigational Network. R. J. received grant support from the National Institutes of Health (National Center for Research Resources, National Institute of Aging). M. R. received institutional grant support from the National Institutes of Health (National Center for Research Resources, National Institute of Aging). Potential conflicts of interest. All authors: No reported conflicts.

PY - 2012/12/15

Y1 - 2012/12/15

N2 - Background. Studies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cause more severe disease than other ribotypes. A growing number of studies challenge the validity of this hypothesis.Methods. We conducted a cross-sectional study of C. difficile infection (CDI) to test whether ribotype predicted clinical severity when adjusted for the influence of other predictors. Toxigenic C. difficile isolates were cultured from stool samples, screened for genes encoding virulence factors by polymerase chain reaction (PCR) and ribotyped using high-throughput, fluorescent PCR ribotyping. We collected data for 15 covariates (microbiologic, epidemiologic, and laboratory variables) and determined their individual and cumulative influence on the association between C. difficile ribotype and severe disease. We then validated this influence using an independent data set.Results. A total of 34 severe CDI cases were identified among 310 independent cases of disease (11.0%). Eleven covariates, including C. difficile ribotype, were significant predictors of severe CDI in unadjusted analysis. However, the association between ribotypes 027 and 078 and severe CDI was not significant after adjustment for any of the other covariates. After full adjustment, severe cases were significantly predicted only by patients' white blood cell count and albumin level. This result was supported by analysis of a validation data set containing 433 independent CDI cases (45 severe cases; 10.4%).Conclusions. Ribotype is not a significant predictor of severe CDI when adjusted for the influence of any other variables separately or in combination. White blood cell count and albumin level are the most clinically relevant predictors of severe CDI cases.

AB - Background. Studies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cause more severe disease than other ribotypes. A growing number of studies challenge the validity of this hypothesis.Methods. We conducted a cross-sectional study of C. difficile infection (CDI) to test whether ribotype predicted clinical severity when adjusted for the influence of other predictors. Toxigenic C. difficile isolates were cultured from stool samples, screened for genes encoding virulence factors by polymerase chain reaction (PCR) and ribotyped using high-throughput, fluorescent PCR ribotyping. We collected data for 15 covariates (microbiologic, epidemiologic, and laboratory variables) and determined their individual and cumulative influence on the association between C. difficile ribotype and severe disease. We then validated this influence using an independent data set.Results. A total of 34 severe CDI cases were identified among 310 independent cases of disease (11.0%). Eleven covariates, including C. difficile ribotype, were significant predictors of severe CDI in unadjusted analysis. However, the association between ribotypes 027 and 078 and severe CDI was not significant after adjustment for any of the other covariates. After full adjustment, severe cases were significantly predicted only by patients' white blood cell count and albumin level. This result was supported by analysis of a validation data set containing 433 independent CDI cases (45 severe cases; 10.4%).Conclusions. Ribotype is not a significant predictor of severe CDI when adjusted for the influence of any other variables separately or in combination. White blood cell count and albumin level are the most clinically relevant predictors of severe CDI cases.

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U2 - 10.1093/cid/cis786

DO - 10.1093/cid/cis786

M3 - Article

C2 - 22972866

AN - SCOPUS:84870192206

SN - 1058-4838

VL - 55

SP - 1661

EP - 1668

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

IS - 12

ER -

Clostridium difficile ribotype does not predict severe infection

Abstract

ASJC Scopus subject areas

UN SDGs

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