title: Clinical characteristics of relapses and re-infections in Clostridium difficile infection.
abstract: The purpose of this study was to identify factors associated with relapses or re-infections in patients with recurring Clostridium difficile infections (CDIs). From September 2008 to January 2012, cases with two or more isolates from consecutive CDI episodes were included. PCR-ribotyping and multilocus variable-number tandem-repeat analysis were performed using paired isolates. Among 473 patients, 68 (14.4%) experienced one to five recurrences. Fifty-one of these with two or more isolates from consecutive CDI episodes were included in the study; 25 (49%) were classified as relapses and 26 (51%) as re-infections. Recurrence interval was shorter in the relapse group (26.0 versus 67.5 p 0.001), but more patients in the re-infection group were hospitalized during recurrence interval (53.8% versus 8.0%, p<0.001). Relapse rates in infections by ribotype 017, ribotype 018 and other ribotypes were 63.6%, 63.6% and 22.2%, respectively (p 0.274, p 0.069, and p 0.005). In multivariate logistic regression, infections by ribotypes 017 and 018 were associated with CDI relapse (OR 4.77, 95% CI 1.02-22.31, p 0.047; OR 11.49, 95% CI 2.07-63.72, p 0.005). Conversely, admission during recurrence interval lowered the risk of relapse (OR 0.044, 95% CI 0.006-0.344, p 0.003). In conclusion, relapse was more likely when infection was caused by PCR ribotypes 017 and 018.
authors.affiliation: Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
authors.forename: J
authors.initials: J
authors.lastname: Kim
authors.forename: M-R
authors.initials: MR
authors.lastname: Seo
authors.forename: J O
authors.initials: JO
authors.lastname: Kang
authors.forename: Y
authors.initials: Y
authors.lastname: Kim
authors.forename: S-P
authors.initials: SP
authors.lastname: Hong
authors.forename: H
authors.initials: H
authors.lastname: Pai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000382:microbiology / Q000473:pathology*; D004269:DNA, Bacterial / Q000235:genetics; D003967:Diarrhea / Q000382:microbiology / Q000473:pathology*; D005260:Female; D005838:Genotype; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018598:Minisatellite Repeats; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D012008:Recurrence; D021521:Ribotyping; D013997:Time Factors
chemical_list: D004269:DNA, Bacterial
keywords: Clostridium difficile infection; PCR ribotyping; multilocus variable-number tandem-repeat analysis; re-infection; recurrence; relapse