Clinical and microbiologic characteristics of tcdA-negative variant clostridium difficile infections

BMC Infectious Diseases

Jung Oak Kang¹  Mi-ran Seo²  Hyunjoo Pai²  Jieun Kim³ 

[1] Department of Laboratory Medicine, Hanyang University College of Medicine, Guri, Korea;Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea;Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea

关键词: ermB gene;    Antimicrobial susceptibility test;    Risk factor;    Clinical outcome;    tcdA-negative variant strain;    Clostridium difficile infection;   

Others  :  1175382
DOI  :  10.1186/1471-2334-12-109

 received in 2011-11-08, accepted in 2012-05-09,  发布年份 2012

【 摘 要 】

Background

The tcdA-negative variant (A^-B⁺) of Clostridium difficile is prevalent in East Asian countries. However, the risk factors and clinical characteristics of A^-B⁺C. difficile infections (CDI) are not clearly documented. The objective of this study was to investigate these characteristics.

Methods

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 C. difficile.

Results

During the study period, we identified 22 cases of CDI caused by tcdA-negative tcdB-positive (A^-B⁺) strains and 105 cases caused by tcdA-positive tcdB-positive (A⁺B⁺) 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^-B⁺ CDI (OR = 4.738, 95% CI 1.48–15.157, p = 0.009 and OR = 0.966, 95% CI 0.935–0.998, p = 0.038, respectively) in logistic regression.

Rates of resistance to clindamycin were 100% and 69.6% in the A^-B⁺ and A⁺B⁺ isolates, respectively (p = 0.006), and the ermB gene was identified in 17 of 21 A^-B⁺ isolates (81%). Resistance to moxifloxacin was also more frequent in the A^-B⁺ than in the A⁺B⁺ isolates (95.2% vs. 63.7%, p = 0.004).

Conclusions

The clinical course of A^-B⁺ CDI is not different from that of A⁺B⁺ CDI. Clindamycin use is a significant risk factor for the acquisition of tcdA-negative variant strains.

【 授权许可】

   
2012 Kim et al; licensee BioMed Central Ltd.

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