title: Clostridium difficile recurrences in Stockholm.
abstract: Sixty-eight hospital-admitted patients with a first episode of Clostridium difficile infection (CDI) were included and followed up during 1 year. Faeces samples were collected at 1, 2, 6 and 12 months after inclusion and analyzed for the presence of C. difficile toxin B, genes for toxin A, toxin B, binary toxin and TcdC deletion by PCR. All strains were also PCR-ribotyped and the MICs of the isolates were determined against eight antimicrobial agents. In 68 patients initially included, antibiotics, clinical signs and co-morbidities were analyzed and 56 were evaluable for recurrences. The mean number of different antibiotics given during 3 months prior to inclusion was 2.6 (range 0-6). Six patients had not received any antibiotics and three of them had diagnosed inflammatory bowel disease. Thirty-two patients (57%) had either a microbiological or clinical recurrence, 16 of whom had clinical recurrences that were confirmed microbiologically (13, 23%) or unconfirmed by culture (3, 5%). Twenty-nine patients were positive in at least one of the follow-up tests, 16 had the same ribotype in follow-up tests, i.e. relapse, and 13 a different ribotype, i.e., reinfection. Most common ribotypes were 078/126, 020, 023, 026, 014/077, 001 and 005. No strain of ribotype 027 was found. Strains ribotype 078/126 and 023 were positive for binary toxin and were the strains most prone to cause recurrence. All strains were sensitive to vancomycin and metronidazole. Patients with recurrences were significantly older (p = 0.02) and all patients had a high burden of comorbidities, which could explain the high fatality rate, 26 (38%) patients died during the 1-year follow-up.
authors.affiliation: Karolinska Institutet, Department of Medicine, Division of Infectious Diseases, Södersjukhuset, SE-118 83 Stockholm, Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Sandell
authors.affiliation: Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
authors.forename: Mamun-Ur
authors.initials: MU
authors.lastname: Rashid
authors.affiliation: Karolinska Institutet, Department of Medicine, Division of Infectious Diseases, Södersjukhuset, SE-118 83 Stockholm, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Jorup-Rönström
authors.affiliation: Karolinska Institutet, Department of Medicine, Division of Infectious Diseases, Södersjukhuset, SE-118 83 Stockholm, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Ellström
authors.affiliation: Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden. Electronic address: carl.erik.nord@ki.se.
authors.forename: Carl Erik
authors.initials: CE
authors.lastname: Nord
authors.affiliation: Karolinska Institutet, Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden.
authors.forename: Andrej
authors.initials: A
authors.lastname: Weintraub
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D015373:Bacterial Typing Techniques; D016360:Clostridioides difficile / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D003015:Clostridium Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D015897:Comorbidity; D024881:Drug Resistance, Bacterial; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012008:Recurrence; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic treatment; Clinical recurrence; Clostridium difficile infection; Microbiological recurrence; Minimum inhibitory concentration; Ribotyping