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Volume 19, Number 9—September 2013

Letter

Clostridium difficile Infection Caused by Binary Toxin–Positive Strains

Marjolein P.M. Hensgens and Ed J. KuijperComments to Author 
Author affiliations: Leiden University Medical Center, Leiden, the Netherlands

Main Article

Table

Thirty-day mortality rates, stratified by binary toxin status, for persons with Clostridium difficile infection, the Netherlands, 2006–2009*

Binary toxin status of infecting strain Absolute 30-day mortality
Relative 30-day mortality, HR (95% CI)†
No adjustment Adjusted for age Adjusted for age and concurrent condition
No. % (95% CI) Method 1 Method 2 Method 3
Positive
027, N = 55 12 22 (13–35) 2.2 (1.2–4.2) 2.0 (1.1–3.8) 2.4 (1.1–5.5) 2.0 (0.8–5.4) 2.0 (0.7–5.5)
Non-027, N = 100 15 15 (9–23) 1.5 (0.8–2.6) 1.4 (0.8–2.5) 1.3 (0.6–2.7) 1.1 (0.5–2.8) 1.1 (0.4–2.9)
Negative, N = 471‡ 50 11 (8–14) 1.0 (ref) 1.0 (ref) 1.0 (ref) 1.0 (ref) 1.0 (ref)
Unknown, N = 724§ 100 14 (11–17) 1.3 (0.9–1.9) 1.3 (0.9–1.9) 1.4 (0.9–2.2) 1.5 (0.9–2.3) 1.3 (0.7–2.4)

*HR, hazard ratio; ref, reference.
†In the model, age and Charlson index were added as continuous variables; all others were dichotomous. Method 1, adjusted for age and history of admissions and antimicrobial drug use in the prior 3 mos. Method 2, adjusted for age; diseases of the respiratory, digestive, circulatory, and genitourinary systems; endocrine diseases; neoplasms and other diseases; history of admissions and antimicrobial drug use in the prior 3 mos. Method 3, adjusted for age; history of admissions; antimicrobial drug use in the prior 3 mos.; and Charlson comorbidity index.
‡Binary toxin–positive non-027 strains belonged to 8 PCR ribotypes (76% type 078).
§Binary toxin–negative strains belonged to 64 different PCR ribotypes (23% type 014).

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