NAP1 Strain Type Predicts Outcomes from Clostridium difficile Infection
Published Date:Mar 5 2014
Source:Clin Infect Dis. 58(10):1394-1400.
Bacterial Typing Techniques
Drug Resistance, Bacterial
Electrophoresis, Gel, Pulsed-Field
Pubmed Central ID:PMC4697926
Funding:U50CK000198/CK/NCEZID CDC HHS/United States
U50CK000195/CK/NCEZID CDC HHS/United States
U50CK000196/CK/NCEZID CDC HHS/United States
U50CK000201/CK/NCEZID CDC HHS/United States
CC999999/Intramural CDC HHS/United States
U50CK000204/CK/NCEZID CDC HHS/United States
U50CK000197/CK/NCEZID CDC HHS/United States
U50CK000203/CK/NCEZID CDC HHS/United States
U50CK000194/CK/NCEZID CDC HHS/United States
U50CK000199/CK/NCEZID CDC HHS/United States
U50CK000205/CK/NCEZID CDC HHS/United States
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.
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.
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).
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.
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