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Clinical characteristics of infections with Clostridium difficile ribotype 027 versus other ribotypes: data from prospective surveillance in Belgium

Abstract number: P2038

Lambert M-L., Van Broeck J., Fontaine C., Pulincks C., Avesani V., Delmée M.

Objectives: to compare clinical characteristics of patients infected with C. difficile ribotype 027, and those with other ribotypes.

Methods: we linked patient data from the prospective surveillance of C. difficile in Belgian hospitals, with typing data from the Belgian C. difficile reference laboratory. We compared CDI with, and without, ribotype 027, in terms of patient characteristics, type of infection (hospital-associated, or not), length of stay in hospital post infection, and outcome.

Results: Laboratory data were available for 980 episodes of C. difficile infections (CDI) which occurred between July 1, 2006, and June 30, 2008 across 80 Belgian hospitals; 211/980 (21.5%) strains belonged to the ribotype 027. Simple univariate comparisons can be found in the table.

Using logistic regression, and taking into account the clustering effect of hospitals, we modelled the probability of CDI-related death (CDI as direct or indirect cause of death, dependant variable) using as covariate age (<80 vs geqslant R: gt-or-equal, slanted80), sex, severity of underlying condition (not fatal, ultimately fatal, fulminant or rapidly fatal), and the ribotype (ribo 027 vs other). We also added the time from infection to discharge (1–7 days, 8–14 days, geqslant R: gt-or-equal, slanted14 days) in the model to account for the time-dependant nature of the observations.

Age over 80 (odds ratio, OR 1.6, p =0.01) and the severity of underlying condition, but not sex, were independent predictors of CDI-related death. Infection with ribotype 027 was associated with an OR of 1.9 (p = 0.041).

Conclusions: In this large prospective study, patient data and laboratory data were collected independently and are therefore free from any differential bias. CDI with ribotype 027 were no more frequent in hospital-associated cases than in imported cases, and resulted only in slightly higher length of stay after infection, but the odds to die from a ribotype 027 CDI were almost double than the odds of dying from CDI with another ribotype.

Table: Comparison of C. difficile infections caused by C. difficile ribotype 027, and other ribotypes

 Ribotype 027
(N = 211)
Other ribotypes
(N = 769)
Ratio of proportionsP (c2)
 n%n%  
Female gender13664%40953%1.20.00
Age geqslant R: gt-or-equal, slanted8012157%32342%1.40.00
Hospital-associated CDI (geqslant R: gt-or-equal, slanted2 days after admission)13062%48663%1.00.8
Underlying condition fulminant or rapidly fatal2713%9512%1.00.7
Death4823%15020%1.20.3
CDI-related death3316%8511%1.40.06
Median time from infection (or hospital admission for imported cases) to discharge, days    20    19    ns*
Median time from infection to CDI-related death, days (N = 114 CDI-related deaths)    14    15    ns*
*Mann-Whitney test – comparison of medians.

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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