title: Role of binary toxin in the outcome of Clostridium difficile infection in a non-027 ribotype setting.
abstract: Binary toxin (BT) has been associated with strains causing more severe Clostridium difficile infection (CDI), such as ribotype 027. Data on the outcome of patients having BT present in ribotypes other than 027 are scarce. Our objective was to investigate the association between BT isolates and outcome of CDI in a non-027 ribotype setting. We prospectively included CDI episodes (January-June 2013 and March-June 2014) from symptomatic patients aged >2 years. Epidemiological and clinical data were recorded. BT genes were detected using multiplex PCR. During the study period, we identified 326 episodes of CDI, of which 319 were available for molecular analysis. Of these, 54 (16·9%) were caused by C. difficile strains with BT. Most (90·7%) isolates with BT were ribotype 078/126. CDI patients with BT-positive strains did not differ from those with BT-negative strains in terms of recurrence (13·0% vs. 15·5%, P = 0·835), treatment failure (0·0% vs. 2·3%, P = 0·594), overall mortality (11·1% vs. 9·1%, P = 0·612), or CDI-related mortality (0·0% vs. 1·9%, P = 0·612). Multivariate regression revealed no association between BT and poor outcome. In conclusion, in a non-027 setting, we found that most BT isolates were 078/126 and were not associated with poor outcome.
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases,Hospital General Universitario Gregorio Marañón,Madrid,Spain.
authors.forename: E
authors.initials: E
authors.lastname: Reigadas
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases,Hospital General Universitario Gregorio Marañón,Madrid,Spain.
authors.forename: L
authors.initials: L
authors.lastname: Alcalá
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases,Hospital General Universitario Gregorio Marañón,Madrid,Spain.
authors.forename: M
authors.initials: M
authors.lastname: Marín
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases,Hospital General Universitario Gregorio Marañón,Madrid,Spain.
authors.forename: A
authors.initials: A
authors.lastname: Martín
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases,Hospital General Universitario Gregorio Marañón,Madrid,Spain.
authors.forename: C
authors.initials: C
authors.lastname: Iglesias
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases,Hospital General Universitario Gregorio Marañón,Madrid,Spain.
authors.forename: E
authors.initials: E
authors.lastname: Bouza
mesh_terms: D036002:ADP Ribose Transferases / Q000235:genetics* / Q000378:metabolism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000235:genetics* / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000235:genetics / Q000502:physiology*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D001426:Bacterial Proteins; D036002:ADP Ribose Transferases; C410164:actin-specific ADP-ribosyltransferase, Clostridium
keywords: Binary toxin; Clostridium difficile infection; outcome; recurrence; ribotype; severe