M Falcone1, G Tiseo2, F Iraci3, G Raponi3, P Goldoni3, D Delle Rose4, I Santino5, P Carfagna6, R Murri7, M Fantoni7, C Fontana8, M Sanguinetti9, A Farcomeni3, G Antonelli10, A Aceti11, C Mastroianni3, M Andreoni4, R Cauda7, N Petrosillo12, M Venditti3. 1. Division of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Pisa, Rome, Italy. Electronic address: marco.falcone@unipi.it. 2. Department of Internal Medicine and Medical Specialties, 'Sapienza' University of Rome, Rome, Italy. 3. Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy. 4. Department of Infectious Diseases, University of Rome Tor Vergata, Rome, Italy. 5. Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy. 6. Department of Internal Medicine, Azienda Ospedaliera San Giovanni, Rome, Italy. 7. Institute of Infectious Diseases, Catholic University of Rome, Rome, Italy. 8. Microbiology Section, University of Rome Tor Vergata, Rome, Italy. 9. Institute of Microbiology, Catholic University of Rome, Rome, Italy. 10. Department of Molecular Medicine, 'Sapienza' University of Rome, Rome, Italy. 11. Infectious Diseases Unit, Azienda Ospedaliera Sant'Andrea, 'Sapienza' University of Rome, Rome, Italy. 12. Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases L. Spallanzani, Rome, Italy.
Abstract
OBJECTIVES: Our objective was to evaluate factors associated with recurrence in patients with 027+ and 027- Clostridium difficile infection (CDI). METHODS: Patients with CDI observed between January and December 2014 in six hospitals were consecutively included in the study. The 027 ribotype was deduced by the presence of tcdB, tcdB, cdt genes and the deletion Δ117 in tcdC (Xpert® C. difficile/Epi). Recurrence was defined as a positive laboratory test result for C. difficile more than 14 days but within 8 weeks after the initial diagnosis date with reappearance of symptoms. To identify factors associated with recurrence in 027+ and 027- CDI, a multivariate analysis was performed in each patient group. Subdistributional hazard ratios (sHRs) and 95% confidence intervals (95%CIs) were calculated. RESULTS: Overall, 238 patients with 027+ CDI and 267 with 027- CDI were analysed. On multivariate analysis metronidazole monotherapy (sHR 2.380, 95%CI 1.549-3.60, p <0.001) and immunosuppressive treatment (sHR 3.116, 95%CI 1.906-5.090, p <0.001) were factors associated with recurrence in patients with 027+ CDI. In this patient group, metronidazole monotherapy was independently associated with recurrence in both mild/moderate (sHR 1.894, 95%CI 1.051-3.410, p 0.033) and severe CDI (sHR 2.476, 95%CI 1.281-4.790, p 0.007). Conversely, non-severe disease (sHR 3.704, 95%CI 1.437-9.524, p 0.007) and absence of chronic renal failure (sHR 16.129, 95%CI 2.155-125.000, p 0.007) were associated with recurrence in 027- CDI. CONCLUSIONS: Compared to vancomycin, metronidazole monotherapy appears less effective in curing CDI without relapse in the 027+ patient group, independently of disease severity.
OBJECTIVES: Our objective was to evaluate factors associated with recurrence in patients with 027+ and 027- Clostridium difficileinfection (CDI). METHODS:Patients with CDI observed between January and December 2014 in six hospitals were consecutively included in the study. The 027 ribotype was deduced by the presence of tcdB, tcdB, cdt genes and the deletion Δ117 in tcdC (Xpert® C. difficile/Epi). Recurrence was defined as a positive laboratory test result for C. difficile more than 14 days but within 8 weeks after the initial diagnosis date with reappearance of symptoms. To identify factors associated with recurrence in 027+ and 027- CDI, a multivariate analysis was performed in each patient group. Subdistributional hazard ratios (sHRs) and 95% confidence intervals (95%CIs) were calculated. RESULTS: Overall, 238 patients with 027+ CDI and 267 with 027- CDI were analysed. On multivariate analysis metronidazole monotherapy (sHR 2.380, 95%CI 1.549-3.60, p <0.001) and immunosuppressive treatment (sHR 3.116, 95%CI 1.906-5.090, p <0.001) were factors associated with recurrence in patients with 027+ CDI. In this patient group, metronidazole monotherapy was independently associated with recurrence in both mild/moderate (sHR 1.894, 95%CI 1.051-3.410, p 0.033) and severe CDI (sHR 2.476, 95%CI 1.281-4.790, p 0.007). Conversely, non-severe disease (sHR 3.704, 95%CI 1.437-9.524, p 0.007) and absence of chronic renal failure (sHR 16.129, 95%CI 2.155-125.000, p 0.007) were associated with recurrence in 027- CDI. CONCLUSIONS: Compared to vancomycin, metronidazole monotherapy appears less effective in curing CDI without relapse in the 027+ patient group, independently of disease severity.