title: Binary toxin and death after Clostridium difficile infection.
abstract: 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.
authors.affiliation: European Programme for Intervention Epidemiology Training, Stockholm, Sweden. cci@ssi.dk
authors.forename: Sabrina
authors.initials: S
authors.lastname: Bacci
authors.forename: Kåre
authors.initials: K
authors.lastname: Mølbak
authors.forename: Marianne K
authors.initials: MK
authors.lastname: Kjeldsen
authors.forename: Katharina E P
authors.initials: KE
authors.lastname: Olsen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism; D001427:Bacterial Toxins / Q000235:genetics / Q000378:metabolism; D016360:Clostridioides difficile / Q000472:pathogenicity / Q000502:physiology*; D003015:Clostridium Infections / Q000378:metabolism / Q000382:microbiology* / Q000401:mortality*; D004768:Enterotoxins / Q000235:genetics / Q000378:metabolism; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012306:Risk; D013997:Time Factors
chemical_list: D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile