Laboratory Markers as Predictors of Mortality in Patients with Clostridium difficile Infection

Pant, Chaitanya; Madonia, Phillip; Minocha, Anil; Manas, Kenneth; Jordan, Paul; Bass, Pat F.

doi:10.2310/jim.0b013e3181bca525

Cited by 15 publications

(10 citation statements)

References 13 publications

(11 reference statements)

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“…As such, in an early infection, the general health condition is altered by 5758-ST01 infection but not by non-ST01 strains. These findings have been described in the severe outcome of CDI in humans [ 40 , 41 ], which suggest a severe pathology in animals infected by the 5758-ST01 strain.…”

Section: Discussionsupporting

confidence: 63%

In vivo animal models confirm an increased virulence potential and pathogenicity of the NAP1/RT027/ST01 genotype within the Clostridium difficile MLST Clade 2

et al. 2020

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Background Based on MLST analyses the global population of C. difficile is distributed in eight clades, of which Clade 2 includes the “hypervirulent” NAP1/RT027/ST01 strain along with various unexplored sequence types (STs). Methods To clarify whether this clinically relevant phenotype is a widespread feature of C. difficile Clade 2, we used the murine ileal loop model to compare the in vivo pro-inflammatory (TNF-α, IL-1β, IL-6) and oxidative stress activities (MPO) of five Clade 2 clinical C. difficile isolates from sequence types (STs) 01, 41, 67, and 252. Besides, we infected Golden Syrian hamsters with spores from these strains to determine their lethality, and obtain a histological evaluation of tissue damage, WBC counts, and serum injury biomarkers (LDH, ALT, AST, albumin, BUN, creatinine, Na+, and Cl−). Genomic distances were calculated using Mash and FastANI to explore whether the responses were dictated by phylogeny. Results The ST01 isolate tested ranked first in all assays, as it induced the highest overall levels of pro-inflammatory cytokines, MPO activity, epithelial damage, biochemical markers, and mortality measured in both animal models. Statistically indistinguishable or rather similar outputs were obtained for a ST67 isolate in tests such as tissue damage, neutrophils count, and lethal activity. The results recorded for the two ST41 isolates tested were of intermediate magnitude and the ST252 isolate displayed the lowest pathogenic potential in all animal experiments. This ordering matched the genomic distance of the ST01 isolate to the non-ST01 isolates. Conclusions Despite their close phylogenic relatedness, our results demonstrate differences in pathogenicity and virulence levels in Clade 2 C. difficile strains, confirm the high severity of infections caused by the NAP1/RT027/ST01 strain, and highlight the importance of C. difficile typing.

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Section: Discussionsupporting

confidence: 63%

In vivo animal models confirm an increased virulence potential and pathogenicity of the NAP1/RT027/ST01 genotype within the Clostridium difficile MLST Clade 2

et al. 2020

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“…Commonly, X 2 , or Fisher’s exact test, was used for categorical data analysis, while a t test was used for continuous variables [14,20]. Kaplan–Meier survival analysis and regression model were used in some studies [18,23,28,30,32,33]. Not all studies undertook adjustment for variables when determining mortality rates.…”

Section: Resultsmentioning

confidence: 99%

Mortality and Clostridium difficile infection: a review

Mitchell

Gardner

2012

Antimicrob Resist Infect Control

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BackgroundClostridium difficile infection (CDI) is a common cause of diarrhoea in hospitalised patients. Around the world, the incidence and severity of CDI appears to be increasing, particularly in the northern hemisphere. The purpose of this integrative review was to investigate and describe mortality in hospitalised patients with CDI.MethodsA search of the literature between 1 January 2005 and 30 April 2011 focusing on mortality and CDI in hospitalised patients was conducted using electronic databases. Papers were reviewed and analysed individually and themes were combined using integrative methods.ResultsAll cause mortality at 30 days varied from 9% to 38%. Three studies report attributable mortality at 30 days, varying from 5.7% to 6.9%. In hospital mortality ranged from 8% to 37.2%ConclusionAll cause 30 day mortality appeared to be high, with 15 studies indicating a mortality of 15% or greater. Findings support the notion that CDI is a serious infection and measures to prevent and control CDI are needed. Future studies investigating the mortality of CDI in settings outside of Europe and North America are needed. Similarly, future studies should include data on patient co-morbidities.

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“…We can speculate that patients with ESRD might be more vulnerable to diarrhea-induced perturbations in fluid and electrolyte or the systemic inflammatory response associated with severe cases of CDI than the general hospitalized patient population. 18 …”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile Infection is Associated with Poor Outcomes in End-Stage Renal Disease

Pant

Deshpande²,

Anderson

et al. 2012

Journal of Investigative Medicine

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Laboratory Markers as Predictors of Mortality in Patients with Clostridium difficile Infection

Cited by 15 publications

References 13 publications

In vivo animal models confirm an increased virulence potential and pathogenicity of the NAP1/RT027/ST01 genotype within the Clostridium difficile MLST Clade 2

In vivo animal models confirm an increased virulence potential and pathogenicity of the NAP1/RT027/ST01 genotype within the Clostridium difficile MLST Clade 2

Mortality and Clostridium difficile infection: a review

Clostridium difficile Infection is Associated with Poor Outcomes in End-Stage Renal Disease

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