1372. Ribotype 027 Strain Does Not Predict the Severity of Clostridium difficile Infection but Predicts Relapse and the Antimicrobial Agent Used
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Emergence of a previously rare and hypervirulent genotype, the NAP1/027 (North American Pulsed-field gel electrophoresis type 1 and PCR ribotype 027) has been associated with higher incidence and severity of Clostridium difficileinfection (CDI). Recent studies have however questioned this assertion. Hence, the objective of this study was to examine the differences between demographics, clinical outcomes and antimicrobial agents used for CDI with and without ribotype 027 in a non-epidemic setting.

Methods: All cases of CDI that occurred over one year period (2/1/2012 to 1/31/2013) at a large community teaching hospital were retrospectively analyzed for the presence of the NAP1/027 strain, severity of CDI, clinical outcomes and antimicrobials used. Case definitions per SHEA-IDSA guidelines were used to classify CDI. Univariate and multivariate analysis were used to identify factors predictive of severe CDI, risk of relapse and choice of antimicrobials used

Results: A total of 195 patients with 220 cases of CDI were identified. All 25 (11.4%) relapses were first relapses. Sixty-five (29.5%) cases were positive for ribotype 027. Patients with ribotype 027 were older (mean age 66.7 vs. 60 years; P=0.04), had a higher rate of healthcare facility (HCF)-onset HCF-associated disease (70.8 % vs. 61.3%; P<0.05) and a higher risk of relapse (OR=3.22, P=0.04). However, it was not associated with severe CDI (26.2% vs. 26.5%), longer duration of stay (10.9 vs. 13.8 days) or higher risk of in-hospital death. Oral metronidazole and vancomycin were used in 142 (64%) and 55 (25%) patients respectively. On multivariate analysis, oral vancomycin was preferred over metronidazole in CDI with ribotype 027 independent of the severity of the infection [OR = 3.67 (1.75-7.70);P<0.01)].

Conclusion: Infection with Clostridium difficile ribotype 027 did not predict severity. However, it was associated with a higher risk of relapse and the use of oral vancomycin as the preferred antimicrobial agent. Physician’s choice of oral vancomycin in patients with CDI should be based on severity or the frequency of relapses rather than by the ribotype identified. In a non-epidemic setting, cost-effectiveness of reporting the ribotype for first episode or first relapse of CDI needs to be further studied.

Ige Abraham George, MD, Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA, Anand R Kumar, MD, Gasteroenterology, Albert Einstein Medical Center, Philadelphia, PA and Jerry Zuckerman, MD, Infectious Diseases, Albert Einstein Medical Center, Philadelphia, PA


I. A. George, None

A. R. Kumar, None

J. Zuckerman, None

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