Mukil Natarajan1, Mary Am Rogers1, Jacob Bundy2, Dejan Micic1, Seth T Walk1,3, Kavitha Santhosh1, Krishna Rao1, Spencer Winters1, Vincent B Young1,4, David M Aronoff1,5. 1. Department of Internal Medicine, University of Michigan School of Medicine, USA. 2. University of Michigan School of Public Health, USA. 3. Department of Microbiology & Immunology, Montana State University, USA. 4. Department of Microbiology and Immunology, University of Michigan School of Medicine, USA. 5. Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, USA.
Abstract
OBJECTIVES: Previous studies suggest that colonization with non-toxigenic Clostridium difficile may protect against toxigenic C. difficile infection (CDI), yet most of the studies were conducted in men. Therefore, we conducted a study to examine this hypothesis in both genders. METHODS: Patients (n=1492) were classified by disease status at baseline and observed for 1 year. Cox proportional hazards regression was used to evaluate CDI rates within 8 weeks post-baseline (short-term) and from 8 weeks to 1 year (long-term follow-up). RESULTS: During short-term follow-up, CDI rates were 5 times greater in females with non-toxigenic Clostridium difficile compared to females without C. difficile (hazard ratio (HR) = 5.13; 95% CI: 1.47-17.83). The comparable HR in males was 0.44 (95% CI: 0.04-4.43). During long term follow-up, CDI rates were similar in those with non-toxigenic C. difficile and those without C. difficile at baseline, for both females and males. Mortality rates were significantly lower for patients colonized by non-toxigenic C. difficile than those with toxigenic C. difficile at baseline, for both genders combined (HR=0.51; 95% CI: 0.28-0.92) and were similar to those with no C. difficile at baseline (HR=0.78; 95% CI: 0.43-1.41). CONCLUSIONS: There were gender differences in the short-term risk of CDI. Mortality was similar for patients colonized with non-toxigenic C. difficile and patients without C. difficile.
OBJECTIVES: Previous studies suggest that colonization with non-toxigenic Clostridium difficile may protect against toxigenic C. difficileinfection (CDI), yet most of the studies were conducted in men. Therefore, we conducted a study to examine this hypothesis in both genders. METHODS:Patients (n=1492) were classified by disease status at baseline and observed for 1 year. Cox proportional hazards regression was used to evaluate CDI rates within 8 weeks post-baseline (short-term) and from 8 weeks to 1 year (long-term follow-up). RESULTS: During short-term follow-up, CDI rates were 5 times greater in females with non-toxigenic Clostridium difficile compared to females without C. difficile (hazard ratio (HR) = 5.13; 95% CI: 1.47-17.83). The comparable HR in males was 0.44 (95% CI: 0.04-4.43). During long term follow-up, CDI rates were similar in those with non-toxigenic C. difficile and those without C. difficile at baseline, for both females and males. Mortality rates were significantly lower for patients colonized by non-toxigenic C. difficile than those with toxigenic C. difficile at baseline, for both genders combined (HR=0.51; 95% CI: 0.28-0.92) and were similar to those with no C. difficile at baseline (HR=0.78; 95% CI: 0.43-1.41). CONCLUSIONS: There were gender differences in the short-term risk of CDI. Mortality was similar for patients colonized with non-toxigenic C. difficile and patients without C. difficile.
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