Binary toxin and its clinical importance in Clostridium difficile infection, Belgium

• Published in: European journal of clinical microbiology & infectious diseases Vol. 35; no. 11; pp. 1741 - 1747
• Main Authors: Pilate, T., Verhaegen, J., Van Ranst, M., Saegeman, V.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-11-2016
• Subjects: ADP Ribose Transferases - genetics; ADP Ribose Transferases - toxicity; Adult; Aged; Bacterial Proteins - genetics; Bacterial Proteins - toxicity; Belgium - epidemiology; Biomedical and Life Sciences; Biomedicine; Clostridium difficile - classification; Clostridium difficile - genetics; Clostridium difficile - metabolism; Clostridium Infections - epidemiology; Clostridium Infections - mortality; Clostridium Infections - pathology; Feces - microbiology; Female; Humans; Internal Medicine; Male; Medical Microbiology; Middle Aged; Original Article; Polymerase Chain Reaction; Recurrence; Retrospective Studies; Ribotyping; Survival Analysis; Diarrhea Patient; tcdC Gene; Cystic Fibrosis Patient; Binary Toxin Gene; Binary Toxin
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-016-2719-4

Binary toxin-producing
Clostridium difficile
strains such as ribotypes 027 and 078 have been associated with increased
Clostridium difficile
infection (CDI) severity. Our objective was to investigate the association between presence of the binary toxin gene and CDI severity and recurrence. We performed a laboratory-based retrospective study including patients between January 2013 and March 2015 whose fecal samples were analyzed by polymerase chain reaction (PCR) for the presence of the genes for toxin B and binary toxin and a deletion in the
tcdC
gene, specific for ribotype 027. Clinical and epidemiological characteristics were compared between 33 binary toxin-positive CDI patients and 33 binary toxin-negative CDI patients. Subsequently, the characteristics of 66 CDI patients were compared to those of 66 diarrhea patients who were carriers of non-toxigenic
C. difficile
strains. Fifty-nine of 1034 (5.7 %) fecal samples analyzed by PCR were binary toxin-positive, belonging to 33 different patients. No samples were positive for ribotype 027. Binary toxin-positive CDI patients did not differ from binary toxin-negative CDI patients in terms of disease recurrence, morbidity, or mortality, except for a higher peripheral leukocytosis in the binary toxin-positive group (16.30 × 10
9
/L vs. 11.65 × 10
9
/L;
p
 = 0.02). The second part of our study showed that CDI patients had more severe disease, but not a higher 30-day mortality rate than diarrhea patients with a non-toxicogenic
C. difficile
strain. In our setting with a low prevalence of ribotype 027, the presence of the binary toxin gene is not associated with poor outcome.