936. Fecal Biomarkers of Clostridium Difficile (CD) Associated Disease (CDAD)
Session: Poster Abstract Session: Clostridium difficile Infections: Epidemiology and Diagnostics
Friday, October 9, 2015
Room: Poster Hall
Posters
  • IDWeek 2015.pdf (111.3 kB)
  • Background: Toxigenic CD detection by nucleic acid amplification tests (NAATS) may not correlate with clinical outcomes and may be insufficient to diagnose CDAD.

    Objective: To evaluate fecal biomarkers as clinical correlates of CDAD.

    Methods: Diarrheal stools positive by the study hospital’s real-time PCR (qPCR) assay for tcdB, BD GeneOhm™ Cdiff, were tested for toxin (C. difficile TOX A/B II ELISA, TechLab), lactoferrin (IBD-SCAN ELISA, TechLab), calprotectin (Human Calprotectin ELISA kit, Hycult Biotech), IL-8 (Quantikine ELISA Kit, R&D Systems), blood (Sure-Vue Fecal Occult Blood Test, Fisher), and toxin A and B genes by qPCR. Severe CDAD was based on >2 points (pts): (1 pt for age >60 years, fever >100.4°F, albumin <2.5 mg/dL, white blood cell count (WBC) >15,000 cells/mL; 2 pts for ICU admission).

    Results: 101 adult CDAD patients were prospectively enrolled (Insert Table). Increased toxigenic CD counts were associated with toxin production (3.1 x 108 tcdA copies/g stool, p<0.001; 1.2 x108 tcdB copies/g stool, p<0.001), peripheral leukocytosis, and fever. Greater toxigenic load was observed with ICU requirement, death, and severe CDAD but was not statistically significant.

    Conclusion: Toxigenic CD load correlates with CDAD severity markers including elevated leukocytosis, fever, and toxin production. Fecal toxigenic load, toxin, IL-8, and lactoferrin production may serve as useful adjunct assays to NAATs in identifying patients with clinically significant CDAD.

    Table. Fecal Markers for PCR-Positive Patients (n=101)

    Positive Fecal Test (%)

    WBC >15,000

    WBC <15,000

    P value

    Fever

    No Fever

    P value

    ICU Admit

    No ICU

    P value

    Severe CDAD

    Mild CDAD

    P value

    Toxin

    19 (54)

    17 (26)

    0.004

    9 (47%)

    27 (33%)

    0.24

    10 (29)

    26 (39)

    0.35

    23 (43)

    13 (28)

    0.12

    Occult blood

    22 (63)

    31 (47)

    0.13

    10 (53)

    43 (52)

    0.99

    21 (62)

    32 (48)

    0.18

    30 (56)

    23 (49)

    0.51

    Calprotectin (n=81)

    21 (100)

    57 (95)

    0.56

    12 (86)

    66 (99)

    0.08

    27 (96)

    51 (96)

    1.00

    40 (93)

    38 (100)

    0.24

    IL-8

    18 (51)

    15 (23)

    0.003

    10 (53)

    23 (28)

    0.04

    10 (29)

    23 (34)

    0.62

    20 (37)

    13 (28)

    0.32

    Lactoferrin

    28 (80)

    37 (56)

    0.02

    14 (74)

    51 (62)

    0.35

    24 (71)

    41 (61)

    0.35

    39 (72)

    26 (55)

    0.08

    Mean tcdA copies/g stool (n=83)

    3.4 x 108

    5.6 x 107

    0.007

    3.6 x 108

    1.1 x 108

    <0.05

    2.4 x 108

    1.1 x 108

    0.75

    2.3 x 108

    6.9 x 107

    0.34

    Mean tcdB copies/g stool (n=88)

    1.4 x 108

    2.2 x 107

    0.02

    1.7 x 108

    4.0 x 107

    0.09

    1.1 x 108

    4.1 x 107

    0.84

    9.8 x 107

    2.5 x 107

    0.19

    Xunyan Ye, PhD1, Meina Zhao, PhD1, Alejandro Restrepo, M.D.1, John Van, BA1, Todd M. Lasco, PhD2, Kevin W. Garey, PharmD, M.S.3, Herbert Dupont, MD, FIDSA4,5,6 and Hoonmo L. Koo, MD, MPH7, (1)Baylor College of Medicine, Houston, TX, (2)Clinical Laboratory, Baylor St Lukes Medical Center, Houston, TX, (3)College of Pharmacy, University of Houston, Houston, TX, (4)Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, (5)St. Luke's Hospital and Kelsey Research Foundation and Kelsey-Seybold Clinic, Houston, TX, (6)University of Texas, School of Public Health, Houston, TX, (7)Baylor College of Medicine, University of Texas-Houston School of Public Health, Houston, TX

    Disclosures:

    X. Ye, None

    M. Zhao, None

    A. Restrepo, None

    J. Van, None

    T. M. Lasco, None

    K. W. Garey, None

    H. Dupont, None

    H. L. Koo, Alere Inc: Provided free test kits for the research , Free test kits were received

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