Clostridium difficile fecal toxin level is associated with disease severity and prognosis. Issue 5 (June 2018)

• Record Type: Journal Article
• Authors: Cohen, Nathaniel A; Miller, Tamar; Na'aminh, Wasef; Hod, Keren; Adler, Amos; Cohen, Daniel; Guzner-Gur, Hanan; Santo, Erwin; Halpern, Zamir; Carmeli, Yehuda; Maharshak, Nitsan
• Is Part Of: United European Gastroenterology journal. Volume 6:Issue 5(2018)
• Page Start: 773
• Page End: 780
• Publication Date: 2018-06
• Subjects: Infectious diarrhea -- infectious colitis -- antibiotics -- Clostridium difficile; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640617750809
• Languages: English
• ISSNs: 2050-6406

Abstract

Background: Antibiotic-associated colitis caused by Clostridium difficile ( C. difficile ) is the most common cause of hospital-acquired diarrhea. The pathogenesis of C. difficile colitis is mediated by bacterial toxins. C. difficile infection (CDI) severity may be determined by the fecal level of these toxins. Objective: The objective of this article is to determine whether fecal C. difficile toxin (CDT) levels are associated with disease severity and prognosis. Methods: A cross-sectional study of patients admitted with CDI in a tertiary center between 2011 and 2015 was conducted. Fecal CDT levels were determined by quantitative ELISA. Severe CDI was defined as a leukocyte count of > 15 × 10 3 cells/μl, creatinine levels that deteriorated by > 1.5 times the baseline level, or albumin levels < 3 g/dl. Results: Seventy-three patients were recruited for this study. Patients with severe CDI ( n = 47) had significantly higher toxin levels compared to patients with mild to moderate CDI ( n = 26) (651 ng/ml (IQR 138–3200) versus 164 ng/ml (IQR 55.2–400.1), respectively; p = 0.001). A high toxin level (>2500 ng/ml) was associated with an increased mortality rate (odds ratio 11.8; 95% confidence interval 2.5–56). Conclusions: The fecal CDT level is associated with disease severity and mortality rate. Measuring CDT levels may be an objective and accurate way to define the severity of CDI.