NAP1 Strain Type Predicts Outcomes from Clostridium difficile Infection

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  See, Isaac ; Mu, Yi ; Cohen, Jessica ; Beldavs, Zintars G. ; Winston, Lisa G. ; Dumyati, Ghinwa ; Holzbauer, Stacy ; Dunn, John ; Farley, Monica M. ; Lyons, Carol ; Johnston, Helen ; Phipps, Erin ; Perlmutter, Rebecca ; Anderson, Lydia ; Gerding, Dale N. ; Lessa, Fernanda C.
• Description:
  Background
  
  Studies conflict regarding the importance of the fluoroquinolone-resistant North American pulsed-field gel electrophoresis type 1 (NAP1) strain in Clostridium difficile infection (CDI) outcome. We describe strain types causing CDI and evaluate their association with patient outcomes.
  
  Methods
  
  CDI cases were identified from population-based surveillance. Multivariate regression models were used to evaluate the associations of strain type with severe disease (ileus, toxic megacolon, or pseudomembranous colitis within 5 days; or white blood cell count ≥15,000/mm3 within one day of positive test), severe outcome (intensive care unit admission after positive test, colectomy for C. difficile infection, or death within 30 days of positive test), and death within 14 days of positive test.
  
  Results
  
  Strain typing results were available for 2,057 cases. Severe disease occurred in 363 (17.7%) cases, severe outcome in 100 (4.9%), and death within 14 days in 56 (2.7%). The most common strain types were NAP1 (28.4%), NAP4 (10.2%) and NAP11 (9.1%). In unadjusted analysis, NAP1 was associated with greater odds of severe disease than other strains. After controlling for patient risk factors, healthcare exposure, and antibiotic use, NAP1 was associated with severe disease (adjusted odds ratio [aOR] 1.74, 95% confidence interval [CI], 1.36–2.22), severe outcome (aOR 1.66, 95% CI, 1.09–2.54), and death within 14 days (aOR 2.12, 95% CI, 1.22–3.68).
  
  Conclusion
  
  NAP1 was the most prevalent strain and a predictor of severe disease, severe outcome, and death. Strategies to reduce NAP1 prevalence, such as antibiotic stewardship to reduce fluoroquinolone use, might reduce CDI morbidity.
  
  
• Subjects:
  Aged Anti-Bacterial Agents Bacterial Typing Techniques Clostridioides Difficile Clostridium Infections Drug Resistance, Bacterial Electrophoresis, Gel, Pulsed-Field Enterocolitis, Pseudomembranous Female Fluoroquinolones Hospitalization Humans Megacolon, Toxic Middle Aged Population Surveillance Prevalence Risk Factors Treatment Outcome

  More +
• Keywords:
  Clinical Outcomes Clostridium Difficile Epidemiology Strain Typing
• Source:
  Clin Infect Dis. 58(10):1394-1400
• Pubmed ID:
  24604900
• Pubmed Central ID:
  PMC4697926
• Document Type:
  Journal Article
• Funding:
  U50CK000198/CK/NCEZID CDC HHSUnited States/ ; U50CK000195/CK/NCEZID CDC HHSUnited States/ ; CC999999/Intramural CDC HHSUnited States/ ; U50CK000204/CK/NCEZID CDC HHSUnited States/ ; U50CK000205/CK/NCEZID CDC HHSUnited States/ ; U50CK000196/CK/NCEZID CDC HHSUnited States/ ; U50CK000201/CK/NCEZID CDC HHSUnited States/ ; U50CK000197/CK/NCEZID CDC HHSUnited States/ ; U50CK000203/CK/NCEZID CDC HHSUnited States/ ; U50CK000194/CK/NCEZID CDC HHSUnited States/ ; U50CK000199/CK/NCEZID CDC HHSUnited States/
• Volume:
  58
• Issue:
  10
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:055d433bb5ed7f7c6ecb0f7ec83dbf460633b33c31723d82eac0887bb389a953
• Download URL:
  https://stacks.cdc.gov/view/cdc/37164/cdc_37164_DS1.pdf
• File Type:
  [PDF - 681.25 KB ]