Risk factors of fecal toxigenic or non-toxigenic Clostridium difficile colonization: impact of Toll-like receptor polymorphisms and prior antibiotic exposure.
BACKGROUND
This study is to investigate the significance and risk factors of fecal toxigenic (tCdC) or non-toxigenic Clostridium difficile colonization (ntCdC) among hospitalized patients.


METHODS
Adults admitted to medical wards in a district hospital between January 2011 and June 2012 were enrolled, and those with a history of colectomy, C. difficile fecal colonization or infection or receipt of either metronidazole or oral vancomycin within 3 months, were excluded. Stools collected within 48 hours after admission and every week during hospitalization were cultured for C. difficile.


RESULTS
Among the 441 enrolled patients, 84 (20.0%) had CdC at initial screening, including 58 (13.2%) with tCdC and 26 (6.8%) with ntCdC. Among patients with initial negative fecal screening for CdC, it took an average of 70.6 days or 66.5 days to develop tCdC or ntCdC during the study period. Finally 78 (17.7%) had tCdC and 34 (7.7%) had ntCdC. During the follow-up period, the patients with tCdC had a higher risk of CDAD (11/79, 14.1%) than those without CdC (3/328, 0.9%) and those with ntCdC (0/34, 0%) (P<0.001). In multivariate analysis, the TLR4 rs1927914 polymorphism (GG genotype) (odds ratio [OR] 4.4, 95% confidence interval [CI] 1.6-11.8, P = 0.003) and recent cefepime therapy (OR 5.3, 95% CI 2.1-13.2, P<0.001) were independently associated with tCdC, whereas recent cefuroxime (OR 11.7, 95% CI 2.3-60.2, P = 0.003) and glycopeptide therapy (OR 10.9, CI: 2.1-57.2, P = 0.005) associated with ntCdC.


CONCLUSIONS
The incidence of CDAD is highest in patients with tCdC and lowest in patients with ntCdC, and the TLR4 rs1927914 polymorphism GG genotype and recent cefepime therapy were independently associated with tCdC.
Department of Internal Medicine, Tainan Hospital, Department of Health, Executive Yuan, Tainan, Taiwan.
Yuan-Pin
YP
Hung
Hsiao-Ju
HJ
Lin
Tai-Chieh
TC
Wu
Hsiu-Chuan
HC
Liu
Jen-Chieh
JC
Lee
Chih-I
CI
Lee
Yi-Hui
YH
Wu
Lei
L
Wan
Pei-Jane
PJ
Tsai
Wen-Chien
WC
Ko
D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology*; D000077723:Cefepime; D002444:Cefuroxime / Q000494:pharmacology; D002511:Cephalosporins / Q000494:pharmacology; D016360:Clostridioides difficile / Q000187:drug effects* / Q000276:immunology / Q000472:pathogenicity; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000235:genetics* / Q000276:immunology / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology; D008875:Middle Aged; D016017:Odds Ratio; D011110:Polymorphism, Genetic; D012307:Risk Factors; D051197:Toll-Like Receptor 4 / Q000235:genetics / Q000276:immunology*; D014640:Vancomycin / Q000494:pharmacology
D000890:Anti-Infective Agents; D002511:Cephalosporins; C495345:TLR4 protein, human; D051197:Toll-Like Receptor 4; D008795:Metronidazole; D014640:Vancomycin; D000077723:Cefepime; D002444:Cefuroxime