Ribotype 027 Clostridium difficile infections with measurable stool toxin have increased lactoferrin and are associated with a higher mortality

Abstract

We evaluated clinical and diagnostic indicators of severe C. difficile infection (CDI) and their association with poor clinical outcome. A total of 210 patients positive according to PCR (toxin B: tcdB) were included, with patients having a median age of 62 years and a Charlson comorbidity index (CI) score of 5. Ninety-one percent (n=191) were positive by toxigenic culture and 61% (n=129) had stool toxin. Toxin-positive patients had significantly higher fecal lactoferrin (mean 316 μg/g versus 106 μg/g stool; p<0.0001). Forty percent of patients (n=85) were infected with ribotype 027 and significantly more of these patients had measurable stool toxin (79% vs. 50%; p<0.0001). The mean fecal lactoferrin was significantly higher for toxin-positive 027 CDI compared with the 027 toxin-negative group (317 vs 60 μg/g; p=0.0014). Ribotype 027 CDI with stool toxin showed a higher all-cause, 100-day mortality compared with non-027 with stool toxin (36% vs 18%; p=0.017). Logistic regression univariate analysis for odds ratio (OR) and p values revealed that age (OR=1.1), intensive care unit treatment (OR=2.7), CI (OR=1.2), 027 CDI (OR=2.1), white blood cell count (OR=1.0), albumin level (OR=0.1), and stool toxin-positive 027 CDI (OR=2.5) were significantly associated with 100-day mortality (p<0.05). In conclusion, CDI PCR-positive patients with 027 infection and stool toxin have increased lactoferrin and are at an increased risk of death. © The Author(s) 2014.