Impact of Clostridium difficile infection caused by the NAP1/RT027 strain on severity and recurrence during an outbreak and transition to endemicity in a Mexican tertiary care center

Abstract

Objectives: To describe the clinical characteristics, outcomes, and factors associated with Clostridium difficile infection (CDI) due to ribotype 027 (RT027) and recurrence, including an outbreak period, with transition to endemicity. Methods: A case–control study was performed. Clinical and demographic data were collected for patients with CDI during the period January 2008 to December 2015. Ribotyping of the isolates and PCR for toxin A, B, and binary were performed. Results: Among 324 episodes of CDI, 27.7% were caused by RT027. Previous fluoroquinolone use (odds ratio (OR) 1.79, 95% confidence interval (CI) 1.01–3.17), previous gastrointestinal endoscopy (OR 2.17, 95% CI 1.29–3.65), chemotherapy (OR 0.43, 95% CI 0.19–0.95), and total enteral nutrition (OR 0.42, 95% CI 0.18–0.97) were associated with RT027. Age >65 years (OR 2.05, 95% CI 1.02–4.10), severe initial episode (OR 3.35, 95% CI 1.60–6.15), previous proton pump inhibitor use (OR 2.34, 95% CI 1.15–4.74), and continued fluoroquinolones (OR 3.08, 95% CI 1.11–8.51) were associated with recurrence. Among the non-RT027, 59.8% were not assigned by the ribotyping database and 50.7% presented binary toxin. Conclusions: In this population, CDI due to the RT027 strain was not associated with poorer outcomes. This study reinforces the importance of avoiding fluoroquinolones and PPIs to prevent recurrences. The presence of virulence factors among non-RT027 C. difficile strains underscores the importance of performing molecular epidemiology surveillance. Keywords: Clostridium difficile, Recurrence, Molecular epidemiology, Ribotyping