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RT 106 leads to poor clinical outcomes for C Difficult patients

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The specific strain of Clostridioides difficile infection (CDI) could predict the chances of a poor clinical outcome.

A team, led by Masaad Saeed Almutairi, Department of Pharmaceutical Practice and Translational Research, University of Houston College of Pharmacy, investigated the clinical outcome of ribotype (RT) 106 C difficile infections compared to 2 other endemic strains of varying virulence.

Although researchers can identify emerging strains of C difficile, they rarely analyze the impact of different strains on clinical outcomes. RT 106 is one of the most frequently isolated strains of C difficile worldwide. However, studies exploring the clinical results associated with this strain are limited.

The study

In the multicenter study, investigators examined 396 adult patients hospitalized with CDI. The team performed PCR ribotyping on C difficile samples by comparing patients infected with RT 106 (32.3%) with patients infected with RT 027 (29.3%), a known hypervirulent strain or RT 014 -020 (38.3%), a strain associated with less virulence.

Investigators looked for the primary outcomes of poor clinical outcomes, defined as the composite of initial clinical failure, discharge to higher level of care, recurrence of CDI at 90 days, and mortality due to the ICD. Primary outcomes were assessed by blind researchers who reviewed electronic medical records.

Results

Patients infected with RT 014-020 generally had better results than the other 2 groups. This group of patients experienced a poor clinical outcome 40% of the time, compared to RT 106 where 56% of patients had a poor clinical outcome and 65% of patients with RT 027 infection had a poor clinical outcome (P

The investigators also controlled for covariates with RT 014-020 as a comparator and found patients infected with RT 106 (OR, 2.25; 95% CI, 1.36–3.73) or RT 027 (OR, 2 , 56; 95% CI, 1.52–4.31) had a higher likelihood of poor clinical outcomes.

After using RT 027 as a comparator, RT 014-20 had a lower likelihood of poor clinical outcome (OR, 0.42; 95% CI, 0.27-0.65), but not RT 106.

“This study has shown that the emergence It’s hard RT 106 was associated with increased rates of poor clinical outcomes compared to RT 014-020 and poor clinical outcomes comparable to RT 027, ”the authors wrote. “These results may help better understand the clinical significance of this emerging ribotype and future ribotypes. “

C Difficult risk factors

Earlier this year, researchers identified a handful of biomarkers and clinical features that can help clinicians identify individuals at high risk for CDI, including treatment with carbapenems (RR, 5.3; 95% CI, 1.7-16.6), toxigenic It’s hard rectal carriage (HR, 10.3; 95% CI: 3.2-33.1), high intestinal abundance of Enterococcus spp. related to Ruminococcus spp. (HR, 5.4; 95% CI, 2.1-18.7), and a low Shannon alpha diversity index as determined by profiling of the 16S rRNA gene (HR, 9.7 ; 95% CI, 3.2-29.7).

However, normalized urinary 3-indoxyl sulfate levels did not predict an increased risk of C difficile infection.

A total of 135 participants reported 176 episodes of antibiotic-associated diarrhea (AAD), of which 114 episodes in 100 participants occurred within 28 days, while the cumulative incidence of AAD within 28 and 90 days was 10 , 5% (95% CI: 8.6–12.5) and 14.6% (95% CI, 12.4-17.0), respectively.

The study, “Comparative evaluation of clinical outcomes of hospitalized patients infected with Clostridioides difficile ribotype 106 compared to other toxigenic strains”, has been published online in Anaerobe.


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