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. 2011 Jun;17(6):976-82.
doi: 10.3201/eid/1706.101483.

Binary toxin and death after Clostridium difficile infection

Sabrina Bacci  1 , Kåre Mølbak, Marianne K Kjeldsen, Katharina E P Olsen
Affiliations

Binary toxin and death after Clostridium difficile infection

Sabrina Bacci et al. Emerg Infect Dis. 2011 Jun.

Abstract

We compared 30-day case-fatality rates for patients infected with Clostridium difficile possessing genes for toxins A and B without binary toxin (n = 212) with rates for patients infected with C. difficile possessing genes for A, B, and binary toxin. The latter group comprised patients infected with strains of PCR ribotype 027 (CD027, n = 193) or non-027 (CD non-027, n = 72). Patients with binary toxin had higher case-fatality rates than patients without binary toxin, in univariate analysis (relative risk [RR] 1.8, 95% confidence interval [CI] 1.2-2.7) and multivariate analysis after adjustment for age, sex, and geographic region (RR 1.6, 95% CI 1.0-2.4). Similar case-fatality rates (27.8%, 28.0%) were observed for patients infected with CD027 or CD non-027. Binary toxin either is a marker for more virulent C. difficile strains or contributes directly to strain virulence. Efforts to control C. difficile infection should target all virulent strains irrespective of PCR ribotype.

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Figures

Figure 1
Figure 1
Description of Clostridium difficile (CD) infections surveillance in Denmark, with the 4 groups of C. difficile–infected patients included in the study, week 1, 2008–week 22, 2009. SSI, Statens Serum Institut; R, resistance.
Figure 2
Figure 2
Kaplan Meier curves showing the probability of patient survival after diagnosis of Clostridium difficile infection according to the 4 different infection groups (log-rank test, p<0.001). Blue line, C. difficile PCR ribotype 027; black line, C. difficile PCR ribotype non-027; green line, C. difficile with toxins A and B without binary toxin; red line, C. difficile unselected strains not referred for typing.
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