title: Clostridium difficile ribotype 027 is most prevalent among inpatients admitted from long-term care facilities.
abstract: Intestinal inflammation was evaluated using faecal lactoferrin and ribotype in 196 hospitalized adults with Clostridium difficile infection to determine the impact of ribotype 027 in long-term care facilities (LTCFs). LTCF residents (n=28) had greater antibiotic use (P=0.049) and more ribotype 027 infection [odds ratio (OR): 4.87; 95% confidence interval (CI): 2.02-11.74; P<0.01], compared to those admitted from home. Patients infected with ribotype 027 strains had worse six-month mortality (OR: 1.90; 95% CI: 1.08-3.34; P=0.03) and more inflammation (95.26 vs 36.08 μg/mL; P=0.006), compared to those infected with non-027 strains. This study was not designed to determine acquisition site, but, in this population, suggests that the location from which the patient has been admitted is strongly associated with ribotype 027 and more severe C. difficile disease.
authors.affiliation: University of Virginia, Department of Internal Medicine, Division of General Medicine, Geriatrics, and Palliative Care, Section of Geriatrics, Division of Infectious Diseases and International Health, Center for Global Health, Charlottesville, VA, USA. Electronic address: la2e@virginia.edu.
authors.forename: L R
authors.initials: LR
authors.lastname: Archbald-Pannone
authors.affiliation: Research and Development, TechLab, Inc., Blacksburg, VA, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Boone
authors.affiliation: Research and Development, TechLab, Inc., Blacksburg, VA, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Carman
authors.affiliation: Research and Development, TechLab, Inc., Blacksburg, VA, USA.
authors.forename: D M
authors.initials: DM
authors.lastname: Lyerly
authors.affiliation: University of Virginia, Department of Internal Medicine, Division of Infectious Diseases and International Health, Center for Global Health, Charlottesville, VA, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Guerrant
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016360:Clostridioides difficile / Q000145:classification* / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D024841:Fluoroquinolones / Q000494:pharmacology; D006801:Humans; D007297:Inpatients; D008134:Long-Term Care; D008875:Middle Aged; D021521:Ribotyping
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: Clostridium difficile infection; Long-term care residents; Nosocomial diarrhoea; Strain BI/NAP1/027