Association of relapse of Clostridium difficile disease with BI/NAP1/027.
Recurrent Clostridium difficile infection (CDI) occurs in up to 35% of patients. Recurrences can be due to either relapse with the same strain or reinfection with another strain. In this study, multilocus variable-number tandem-repeat analysis (MLVA) was performed on C. difficile isolates from patients with recurrent CDI to distinguish relapse from reinfection. In addition, univariate and multivariate analyses were performed to identify risk factors associated with relapse. Among patients with a single recurrence, relapse due to the original infecting strain was more prevalent than reinfection and the interval between episodes was shorter than among patients who had reinfections. Among patients with >1 recurrence, equal distributions of relapse and reinfection or a combination of the two episode types were observed. Initial infection with the BI/NAP1/027 epidemic clone was found to be a significant risk factor for relapse. This finding may have important implications for patient therapy. Classification of recurrent CDI episodes by MLVA can be utilized to make informed patient care decisions and to accurately define new CDI cases for infection control and reimbursement purposes.
Infectious Diseases Epidemiology Research Unit, Division of Infectious Diseases, University of Pittsburgh School of Medicine and Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania, USA. jwmarsh@pitt.edu
Jane W
JW
Marsh
Rangolee
R
Arora
Jessica L
JL
Schlackman
Kathleen A
KA
Shutt
Scott R
SR
Curry
Lee H
LH
Harrison
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000145:classification / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D016000:Cluster Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018598:Minisatellite Repeats; D017720:Molecular Epidemiology; D058889:Molecular Typing; D012008:Recurrence; D055815:Young Adult