title: Laboratory and Clinical features of EIA Toxin-positive and EIA Toxin-negative Community-acquired Clostridium difficile Infection.
abstract: Studies have described the clinical course of patients with Clostridium difficile infection (CDI) with positive enzyme immunoassay (EIA) for toxins A and B. Limited information is available for the patients with negative EIA but positive for the toxin B gene (TcdB) by the PCR. The aim of our study is to determine if there are any differences that exist among the clinical and laboratory parameters in the patients tested to be positive by EIA for toxin and those who were negative. This is a retrospective cohort study conducted in a 700-bed teaching hospital. We reviewed charts of the patients with presumptive CDI between January 2006 and July 2013. We divided these patients into two groups, EIA-positive and EIA-negative, based on result of EIA for toxins A and B and the requirement for a positive PCR analysis of the TcdB gene. The EIA-positive group had significantly higher white blood cell counts (p<0.001), with a significantly greater percentage of bands (p<0.0001). Albumin and total protein both exhibit significantly (p<0.0001, both comparisons) lower values in the EIA-positive group. Among clinical findings, the EIA-positive group had significantly longer length of hospital stay (p=0.010). These data suggest that an infection with an EIA-negative strain of C. difficile presents laboratory markers closer to those of healthy subjects and clinical features suggesting considerably less severe than infection with EIA-positive C. difficile.
authors.affiliation: Divisions of Gastroenterology and Infectious Diseases, Department of Medicine St. Joseph's Regional Medical Center, Paterson, NJ, USA New York Medical College, Valhalla, NY, USA.
authors.forename: Hiren
authors.initials: H
authors.lastname: Patel
authors.affiliation: Divisions of Gastroenterology and Infectious Diseases, Department of Medicine St. Joseph's Regional Medical Center, Paterson, NJ, USA New York Medical College, Valhalla, NY, USA.
authors.forename: Jeewanjot
authors.initials: J
authors.lastname: Randhawa
authors.affiliation: St. George's University School of Medicine, Grenada, West Indies.
authors.forename: Sushant
authors.initials: S
authors.lastname: Nanavati
authors.affiliation: Divisions of Gastroenterology and Infectious Diseases, Department of Medicine St. Joseph's Regional Medical Center, Paterson, NJ, USA.
authors.forename: L Randy
authors.initials: LR
authors.lastname: Marton
authors.affiliation: Divisions of Gastroenterology and Infectious Diseases, Department of Medicine St. Joseph's Regional Medical Center, Paterson, NJ, USA Division of Gastroenterology, Seton Hall University, South Orange, NJ, USA.
authors.forename: Walid J
authors.initials: WJ
authors.lastname: Baddoura
authors.affiliation: Divisions of Gastroenterology and Infectious Diseases, Department of Medicine St. Joseph's Regional Medical Center, Paterson, NJ, USA St. George's University School of Medicine, Grenada, West Indies Department of Medicine School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA vincent.debari@shu.edu.
authors.forename: Vincent A
authors.initials: VA
authors.lastname: DeBari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001427:Bacterial Toxins / Q000378:metabolism*; D016360:Clostridioides difficile / Q000502:physiology*; D003015:Clostridium Infections / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D017714:Community-Acquired Infections / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D007124:Immunoenzyme Techniques / Q000379:methods*; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D001427:Bacterial Toxins; C488583:Clostridium difficile lethal toxin B; D012709:Serum Albumin
keywords: Clostridium difficile; biomarkers; non-toxigenic C. difficile; toxin A; toxin B