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Clinical and microbiologic characteristics of <it>tcdA</it>-negative variant <it>clostridium difficile</it> infections

By Kim Jieun, Pai Hyunjoo, Seo Mi-ran and Kang Jung

Abstract

<p>Abstract</p> <p>Background</p> <p>The <it>tcdA-</it>negative variant (A<sup>-</sup>B<sup>+</sup>) of <it>Clostridium difficile</it> is prevalent in East Asian countries. However, the risk factors and clinical characteristics of A<sup>-</sup>B<sup>+</sup><it>C. difficile</it> infections (CDI) are not clearly documented. The objective of this study was to investigate these characteristics.</p> <p>Methods</p> <p>From September 2008 through January 2010, the clinical characteristics, medication history and treatment outcomes of CDI patients were recorded prospectively. Toxin characterization and antibiotic susceptibility tests were performed on stool isolates of <it>C. difficile</it>.</p> <p>Results</p> <p>During the study period, we identified 22 cases of CDI caused by <it>tcdA-</it>negative <it>tcdB-</it>positive (A<sup>-</sup>B<sup>+</sup>) strains and 105 cases caused by <it>tcdA-</it>positive <it>tcdB-</it>positive (A<sup>+</sup>B<sup>+</sup>) strains. There was no significant difference in disease severity or clinical characteristics between the two groups. Previous use of clindamycin and young age were identified as significant risk factors for the acquisition of A<sup>-</sup>B<sup>+</sup> CDI (OR = 4.738, 95% CI 1.48–15.157, <it>p</it> = 0.009 and OR = 0.966, 95% CI 0.935–0.998, <it>p</it> = 0.038, respectively) in logistic regression.</p> <p>Rates of resistance to clindamycin were 100% and 69.6% in the A<sup>-</sup>B<sup>+</sup> and A<sup>+</sup>B<sup>+</sup> isolates, respectively (<it>p</it> = 0.006), and the <it>ermB</it> gene was identified in 17 of 21 A<sup>-</sup>B<sup>+</sup> isolates (81%). Resistance to moxifloxacin was also more frequent in the A<sup>-</sup>B<sup>+</sup> than in the A<sup>+</sup>B<sup>+</sup> isolates (95.2% vs. 63.7%, <it>p</it> = 0.004).</p> <p>Conclusions</p> <p>The clinical course of A<sup>-</sup>B<sup>+</sup> CDI is not different from that of A<sup>+</sup>B<sup>+</sup> CDI. Clindamycin use is a significant risk factor for the acquisition of <it>tcdA-</it>negative variant strains.</p

Topics: <it>Clostridium difficile</it> infection, <it>tcdA-</it>negative variant strain, Clinical outcome, Risk factor, Antimicrobial susceptibility test, <it>ermB</it> gene, Internal medicine, RC31-1245, Medicine, R, DOAJ:Internal medicine, DOAJ:Medicine (General), DOAJ:Health Sciences, Infectious and parasitic diseases, RC109-216
Publisher: BioMed Central
Year: 2012
DOI identifier: 10.1186/1471-2334-12-109
OAI identifier: oai:doaj.org/article:21e610ae7cad49199e3e9994ddf63c3c
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