2072. Clinical and epidemiological description of diarrheal episodes caused by Clostridium difficile RT027 in Mexico.
Session: Poster Abstract Session: Clostridium difficile: Epidemiology
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • poster idweek 2016 C diff epi.pdf (215.8 kB)
  • Background: The rate of Clostridium difficile-associated disease (CDAD) is increasing in different regions, including Mexico. In 2004, a new hypervirulent strain of Clostridium difficilewas described (NAP1/RT027), which is associated with high mortality and morbidity and higher recurrence rates. Risk factors previously associated to this strain include older age, fluoroquinolone and proton pump inhibitors (PPI) use. In our hospital, numerous cases of CDAD caused by this strain have been detected since January 2015.

    Methods: We conducted a case-control study. Clinical and demographic data were collected for patients fulfilling case-definition criteria of CDAD (>3 loose stools/24h + positive PCR or Toxin A/B EIA + positive anaerobic culture), from September 2014 to September 2015. Stool samples were cultured in CCFA, performing PCR using Xpert® C. difficile/Epi, preceded or not by GDH detection. All NAP1 strains were confirmed by PFGE.

    Results: We detected 59 cases of CDAD caused by RT027 and 52 by non-RT027 strains. Median age of RT027 was 52 years (IQR 39-61), 48.9% of RT027 and 51% of non-RT027 were male (p=0.45). Previous use of antacids was more frequent among RT027. Median hospital length of stay was 23 days (IQR 12-33) in RT027, and 16 days (IQR 12-27) in non-RT027 (p=0.17). Late response (>5 days) was observed in 40.6% of RT027 and 17.6% of non-RT027 (p=0.009). Recurrences occurred in 37.2% of RT027 and 15% of non-RT027 (p=0.01). Severe disease occurred in 33.8% of RT027 and 30.7% of non-RT027 (p=0.679). In the multivariate analysis, PPI use (OR 3.27; CI 95% 1.31-8.15) and late response (OR 3.54;CI 95% 1.38-9.07) remained independently associated to RT027. Factors associated with recurrence were previous use of clindamycin, carbapenems or quinolones and infection with RT027. In the multivariate model, carbapenem use (OR 3.17; CI 95% 1.22-8.24) and RT027 infection (OR 3.35; CI 95% 1.16-9.71) remained independently associated.

    Conclusion: This study shows that CDAD is an important local health problem. Antacid use is modifiable risk factor and may lead to early recognition of high-risk patients. Given that no difference in severity of disease between the groups was found, it is possible that other equally or more virulent ribotypes are present in our environment.

    Karla María Tamez-Torres, MD1, Pedro Torres-González, MD2, Miguel Enrique Cervera-Hernández, MD1, Norma Irene López-García, BSc3, Eva Plascencia-Morán, MD4, Miriam Bobadilla-Del Valle, PhD3, José Sifuentes-Osornio, MD, FIDSA5 and Alfredo Ponce De León, MD6, (1)Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, (2)Clinical Microbiology Laboratory, Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, (3)Clinical Microbiology Laboratory, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, (4)Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, (5)Medicine Direction, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico, (6)Clinical Microbiology Laboratory, Infectious Diseases, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Disclosures:

    K. M. Tamez-Torres, None

    P. Torres-González, Pfizer: Investigator and Speaker's Bureau , Research grant and Speaker honorarium
    Sanofi-Pasteur: Investigator , Research grant
    Merck Sharp and Dohme: Investigator , Research grant

    M. E. Cervera-Hernández, None

    N. I. López-García, None

    E. Plascencia-Morán, None

    M. Bobadilla-Del Valle, None

    J. Sifuentes-Osornio, Merck Sharp and Dohme: Investigator and Scientific Advisor , Consulting fee and Research grant
    Pfizer: Investigator , Research grant
    Sanofi-Pasteur: Investigator and Speaker's Bureau , Research grant and Speaker honorarium

    A. Ponce De León, Gilead: Speaker's Bureau , Speaker honorarium
    Pfizer: Investigator , Research grant
    Sanofi-Pasteur: Investigator , Research grant
    Merck Sharp and Dohme: Investigator , Research grant

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.