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Risk factors for recurrence in patients with Clostridium difficile infection due to 027 and non-027 ribotype.
Clin Microbiol Infect. 2018 Jun 28;:
Authors: Marco F, Giusy T, Federica I, Giammarco R, Paola G, Diego DR, Iolanda S, Paolo C, Rita M, Massimo F, Carla F, Maurizio S, Alessio F, Guido A, Antonio A, Claudio M, Massimo A, Roberto C, Nicola P, Mario V
Abstract
OBJECTIVES: Our objective was to evaluate factors associated with recurrence in patients with 027+ Clostridium difficile infection (CDI) and 027- CDI.
MATERIALS/METHODS: Patients with CDI observed between January and December 2014 in 6 hospitals were consecutively included in the study. The 027 ribotype was deducted by the presence of tcdB, tcdB, cdt genes and the deletion Δ117 of tcdC (Xpert® C. difficile/Epi). Recurrence was defined as a positive laboratory test result for C. difficile more than 14 days but within 8 weeks after the initial diagnosis date with reappearance of symptoms. To identify factors associated with recurrence in 027+ and 027- CDI, a multivariate analysis was performed in each patient group. Sub-distributional hazard ratios (sHR) and 95% confidence intervals (CIs) were calculated.
RESULTS: Overall, 238 patients with 027+ CDI and 267 with 027- CDI were analyzed. On multivariate analysis metronidazole monotherapy (sHR 2.380, 95% CI 1.549-3.60, p<0.001) and immunosuppressive treatment (sHR 3.116, 95%CI 1.906-5.090, p<0.001) were factors associated with recurrence in patients with 027+ CDI. In this patient group, metronidazole monotherapy was independently associated with recurrence both in mild/moderate (sHR 1.894, 95% CI 1.051-3.410, p=0.033) and severe CDI (sHR 2.476, 95% CI 1.281-4.790, p=0.007). Conversely, non-severe disease (sHR 3.704, 95% CI 1.437-9.524, p=0.007) and absence of chronic renal failure (sHR 16.129, 95% CI 2.155-125.000, p=0.007) were associated with recurrence in 027- CDI.
CONCLUSIONS: Compared to vancomycin, metronidazole monotherapy appears less effective in curing CDI without relapse 027+ patient group, independently from disease severity.
PMID: 29964230 [PubMed - as supplied by publisher]