Infect Chemother.  2013 Jun;45(2):175-183. 10.3947/ic.2013.45.2.175.

Clinical and Microbiologic Characteristics of Clostridium difficile Infection Caused by Binary Toxin Producing Strain in Korea

• Kim J
• Seo MR
• Kang JO
• Choi TY
• Pai H

• KMID: 2284998
• DOI: http://doi.org/10.3947/ic.2013.45.2.175

Abstract

BACKGROUND
Binary toxin-producing Clostridium difficile infections (CDI) are known to be more severe and to cause higher case fatality rates than those by binary toxin-negative isolates. There has been few data of binary toxin-producing CDI in Korea. Objective of the study is to characterize clinical and microbiological trait of CDI cause by binary-toxin producing isolates in Korea.
MATERIALS AND METHODS
From September 2008 through January 2010, clinical characteristics, medication history and treatment outcome of all the CDI patients were collected prospectively. Toxin characterization, PCR ribotyping and antibiotic susceptibility were performed with the stool isolates of C. difficile.
RESULTS
During the period, CDI caused by 11binary toxin-producing isolates and 105 toxin A & toxin B-positive binary toxin-negative isolates were identified. Comparing the disease severity and clinical findings between two groups, leukocytosis and mucoid stool were more frequently observed in patients with binary toxin-positive isolates (OR: 5.2, 95% CI: 1.1 to 25.4, P = 0.043; OR: 7.6, 95% CI: 1.6 to 35.6, P = 0.010, respectively), but clinical outcome of 2 groups did not show any difference. For the risk factors for acquisition of binary toxin-positive isolates, previous use of glycopeptides was the significant risk factor (OR: 6.2, 95% CI: 1.4 to 28.6, P = 0.019), but use of probiotics worked as an inhibitory factor (OR: 0.1, 95% CI: 0.0 to 0.8; P = 0.026). PCR ribotypes of binary toxinproducing C. difficile showed variable patterns: ribotype 130, 4 isolates; 027, 3 isolates; 267 and 122, 1 each isolate and unidentified C1, 2 isolates. All 11 binary toxin-positive isolates were highly susceptible to clindamycin, moxifloxacin, metronidazole, vancomycin and piperacillin-tazobactam, however, 1 of 11 of the isolates was resistant to rifaximin.
CONCLUSIONS
Binary toxin-producing C. difficile infection was not common in Korea and those isolates showed diverse PCR ribotypes with high susceptibility to antimicrobial agents. Glycopeptide use was a risk factor for CDI by those isolates.

Keyword

Clostridium difficile; Binary toxin; Clinical characteristics; PCR ribotype; Susceptibility

MeSH Terms

Anti-Infective Agents
Aza Compounds
Clindamycin
Clostridium
Clostridium difficile
Glycopeptides
Humans
Korea
Leukocytosis
Metronidazole
Polymerase Chain Reaction
Probiotics
Prospective Studies
Quinolines
Ribotyping
Risk Factors
Sprains and Strains
Treatment Outcome
Vancomycin
Anti-Infective Agents
Aza Compounds
Clindamycin
Glycopeptides
Metronidazole
Quinolines
Vancomycin

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