Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study.

<h4>Background</h4>Clostridium difficile is a leading infectious cause of health care associated diarrhoea. Several industrialised countries have reported increased C. difficile infections and outbreaks, which have been attributed to the emergent PCR ribotype 027 strain.<h4>Methods...

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Autores principales:	Oliver W Morgan, Boaventura Rodrigues, Tony Elston, Neville Q Verlander, Derek F J Brown, Jonathan Brazier, Mark Reacher
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2008
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c6ba8384b64c4b819ede3f46b6daf99f
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spelling	oai:doaj.org-article:c6ba8384b64c4b819ede3f46b6daf99f2021-11-25T06:13:03ZClinical severity of Clostridium difficile PCR ribotype 027: a case-case study.1932-620310.1371/journal.pone.0001812https://doaj.org/article/c6ba8384b64c4b819ede3f46b6daf99f2008-03-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/18350149/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Clostridium difficile is a leading infectious cause of health care associated diarrhoea. Several industrialised countries have reported increased C. difficile infections and outbreaks, which have been attributed to the emergent PCR ribotype 027 strain.<h4>Methods and findings</h4>We conducted a case-case study to compare severity of C. difficile disease for patients with 027 versus non-027 ribotypes. We retrospectively collected clinical information about 123/136 patients with C. difficile infections admitted to hospitals in the East of England region in 2006 and from whom stool isolates were cultured and ribotyped as part of an earlier national survey. We defined severe C. difficile disease as having one or more of shock, paralytic ileus, pseudo membranous colitis or toxic megacolon. Patient median age was 83 years old (range 3 to 98, interquartile range 75 to 89), 86% were prescribed antibiotics in the eight weeks before illness onset, 41% had ribotype 027 and 30-day all cause mortality during hospital admission was 21%. Severe disease occurred in 24% (95%CI 13% to 37%) and 17% (95%CI 9% to 27%) of patients with PCR ribotype 027 and non-027 ribotypes respectively. In a multivariable model, ribotype 027 was not associated with severe disease after adjusting for sex, discharge from hospital prior to 60 days of current admission, gastroenteritis on admission, number of initiator antibiotics for C. difficile disease, and hospital where the patient was admitted.<h4>Conclusions</h4>Our study found no evidence to support previous assertions that ribotype 027 is more virulent than other PCR ribotypes. This finding raises questions about the contribution of this strain to the recent increase in C. difficile disease throughout North America and Europe.Oliver W MorganBoaventura RodriguesTony ElstonNeville Q VerlanderDerek F J BrownJonathan BrazierMark ReacherPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 3, Iss 3, p e1812 (2008)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Oliver W Morgan Boaventura Rodrigues Tony Elston Neville Q Verlander Derek F J Brown Jonathan Brazier Mark Reacher Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study.
description	<h4>Background</h4>Clostridium difficile is a leading infectious cause of health care associated diarrhoea. Several industrialised countries have reported increased C. difficile infections and outbreaks, which have been attributed to the emergent PCR ribotype 027 strain.<h4>Methods and findings</h4>We conducted a case-case study to compare severity of C. difficile disease for patients with 027 versus non-027 ribotypes. We retrospectively collected clinical information about 123/136 patients with C. difficile infections admitted to hospitals in the East of England region in 2006 and from whom stool isolates were cultured and ribotyped as part of an earlier national survey. We defined severe C. difficile disease as having one or more of shock, paralytic ileus, pseudo membranous colitis or toxic megacolon. Patient median age was 83 years old (range 3 to 98, interquartile range 75 to 89), 86% were prescribed antibiotics in the eight weeks before illness onset, 41% had ribotype 027 and 30-day all cause mortality during hospital admission was 21%. Severe disease occurred in 24% (95%CI 13% to 37%) and 17% (95%CI 9% to 27%) of patients with PCR ribotype 027 and non-027 ribotypes respectively. In a multivariable model, ribotype 027 was not associated with severe disease after adjusting for sex, discharge from hospital prior to 60 days of current admission, gastroenteritis on admission, number of initiator antibiotics for C. difficile disease, and hospital where the patient was admitted.<h4>Conclusions</h4>Our study found no evidence to support previous assertions that ribotype 027 is more virulent than other PCR ribotypes. This finding raises questions about the contribution of this strain to the recent increase in C. difficile disease throughout North America and Europe.
format	article
author	Oliver W Morgan Boaventura Rodrigues Tony Elston Neville Q Verlander Derek F J Brown Jonathan Brazier Mark Reacher
author_facet	Oliver W Morgan Boaventura Rodrigues Tony Elston Neville Q Verlander Derek F J Brown Jonathan Brazier Mark Reacher
author_sort	Oliver W Morgan
title	Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study.
title_short	Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study.
title_full	Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study.
title_fullStr	Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study.
title_full_unstemmed	Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study.
title_sort	clinical severity of clostridium difficile pcr ribotype 027: a case-case study.
publisher	Public Library of Science (PLoS)
publishDate	2008
url	https://doaj.org/article/c6ba8384b64c4b819ede3f46b6daf99f
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Clinical severity of Clostridium difficile PCR ribotype 027: a case-case study.

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