title: Correlation between fecal calprotectin levels, disease severity and the hypervirulent ribotype 027 strain in patients with Clostridium difficile infection.
abstract: Clostridium difficile is the most common infectious etiology of nosocomial diarrhea. Fecal calprotectin (fc) is a sensitive marker of intestinal inflammation, found to be associated with enteric bacterial infections and inflammatory bowel disease.
  
  
  
  We evaluated fc levels using a Chemiluminescent immunoassay method, in hospitalized patients with C. difficile infection (CDI) diagnosed by molecular stool examination and assessed correlation with virulent ribotype 027 strain infection, antibiotic susceptibility by gradient Etest strip performed on C. difficile colonies and clinical and laboratory measures of disease severity. Statistical analysis was performed for correlation of fc levels with clinical and laboratory parameters, disease severity and patient outcomes.
  
  
  
  Overall 29 patients with CDI were admitted at the Poria medical center in northern Israel, during June 2014-May 2015. Resistance to metronidazole was found in 3 (10.3 %) isolates and to vancomycin in 5 (17.2 %) isolates. Regarding patient outcomes, within 30 days of CDI diagnosis, recurrence of disease occurred in 10 (34.5 %) patients and 2 patients (6.9 %) died. Seven (24.1 %) isolates were C. difficile ribotype 027. Mean fc level was 331.4 μg/g (21-932). Higher fc levels were found in patients with C. difficile ribotype 027 (p < 0.0005). Fc levels were also correlated with elevated peripheral blood white cell count (p = 0.0007). A trend for higher fc levels was found in patients with a higher clostridium severity score index (p = 0.0633). No correlation was found between fecal calprotectin levels and age, sex, functional status, community versus hospital acquired CDI, antibiotic susceptibility, fever, and creatinine levels.
  
  
  
  Our study highlights the fact that fc has a potential role as a biomarker of disease severity and binary toxin producing ribotype associated disease.
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poria, Tiberias, Israel. aperetz@poria.health.gov.il.|Faculty of Medicine, Bar Ilan University, Galilee, Israel. aperetz@poria.health.gov.il.
authors.forename: Avi
authors.initials: A
authors.lastname: Peretz
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poria, Tiberias, Israel.
authors.forename: Linda
authors.initials: L
authors.lastname: Tkhawkho
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poria, Tiberias, Israel.
authors.forename: Nina
authors.initials: N
authors.lastname: Pastukh
authors.affiliation: Clinical Microbiology Laboratory, Baruch Padeh Medical Center, Poria, Tiberias, Israel.
authors.forename: Diana
authors.initials: D
authors.lastname: Brodsky
authors.affiliation: The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel.
authors.forename: Chen Namimi
authors.initials: CN
authors.lastname: Halevi
authors.affiliation: Faculty of Medicine, Bar Ilan University, Galilee, Israel.|Unit of Infectious Diseases, Baruch Padeh Medical Center, Poria, Tiberias, Israel.
authors.forename: Orna
authors.initials: O
authors.lastname: Nitzan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000032:analysis; D016360:Clostridioides difficile / Q000235:genetics* / Q000302:isolation & purification / Q000502:physiology; D003015:Clostridium Infections / Q000378:metabolism / Q000382:microbiology* / Q000503:physiopathology; D003428:Cross Infection; D024881:Drug Resistance, Bacterial; D005243:Feces / Q000737:chemistry*; D005260:Female; D006760:Hospitalization; D006761:Hospitals; D006801:Humans; D007118:Immunoassay; D007249:Inflammation; D007557:Israel; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D007964:Leukocytosis / Q000097:blood; D008297:Male; D008795:Metronidazole; D008875:Middle Aged; D012008:Recurrence; D021521:Ribotyping; D012720:Severity of Illness Index; D014640:Vancomycin; D055815:Young Adult
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D008795:Metronidazole; D014640:Vancomycin
keywords: Calprotectin; Clostridium difficile; Clostridium severity score index; Ribotype 027