Patient and Strain Characteristics Associated With Clostridium difficile Transmission and Adverse Outcomes. (12th April 2018)

• Record Type: Journal Article
• Authors: Martin, Jessica S H; Eyre, David W; Fawley, Warren N; Griffiths, David; Davies, Kerrie; Mawer, Damian P C; Peto, Timothy E A; Crook, Derrick W; Walker, A Sarah; Wilcox, Mark H
• Is Part Of: Clinical infectious diseases. Volume 67:Number 9(2018)
• Page Start: 1379
• Page End: 1387
• Publication Date: 2018-04-12
• Subjects: Clostridium difficile -- whole-genome sequencing -- outcome; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciy302
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract : Combining epidemiological, clinical, and genomic data for Clostridium difficile cases offers fresh insight into characteristics associated with transmission and outcome. C. difficile lineages may have different reservoirs and modes of transmission, and recent strain acquisition is associated with poorer outcomes. Abstract: Background: No study has used whole-genome sequencing (WGS) to investigate risk factors for Clostridium difficile (CD) transmission between cases, or assessed the impact of recent acquisition on patient outcome. Methods: This 20 month retrospective cohort study included consecutive cytotoxin-positive diarrheal samples, which underwent culture, ribotyping, and WGS (Illumina). Sequenced isolates were compared using single nucleotide variants (SNVs). Independent predictors of acquisition from another case, onward transmission, 120-day recurrence, and 30-day mortality were identified using logistic regression with backwards elimination. Results: Of 660 CD cases, 640 (97%) were sequenced, of which 567 (89%) shared a ribotype with a prior case, but only 227 (35%) were ≤2 SNVs from a prior case, supporting recent acquisition. Plausible (<2 SNVs) recent ward-based acquisition from a symptomatic case was more frequent in certain ribotypes; 64% (67/105) for ribotype-027 cases, compared with 11% (6/57) for ribotype-078. Independent risk factors (adjusted P < .05) for CD acquisition included older age, longer inpatient duration, and ribotype; these factors, and male sex, increased onward transmission. Patients with a plausible donor had a greater risk of recurrence (adjusted P = .001) and trended towards greater 30-day mortality (adjusted P = .06). Ribotype had no additional mortality or recurrence impact after adjusting for acquisition ( P > .1). Conclusions: Greater transmission of certain lineages suggests CD may have different reservoirs and modes of transmission. Acquiring CD from a recent case is associated with poorer clinical outcomes. Clinical characteristics associated with increased healthcare-associated CD transmission could be used to target preventative interventions.