TITLE:
Characteristics, Treatment, and Outcomes Associated with Clostridium difficile Associated Diarrhea in a Veterans Affairs Medical Center
AUTHORS:
David B. Huang, Han Lee, Tom Chiang
KEYWORDS:
Clostridium difficile; BI/NAP1/027; Treatment; Outcomes
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.4 No.1,
February
27,
2014
ABSTRACT: We conducted a study to
assess the characteristics, treatment and outcomes associated with Clostridium difficile associated
diarrhea in a Veterans Affairs Medical Center. Fifty-eight consecutive
individual cases of C. difficile infection
in 2013 were observed within the Veterans Affairs New Jersey Health Care System
(VA NJHCS). We molecularly typed all 58 individual strains and identified the
associated characteristics, treatment and
outcomes. Forty-four out of 58 specimens (76%) which
were probed had characteristics of the epidemic strain BI/NAP1/027 making
this virulent strain to be the predominate strain
at the VA NJHCS. All C. difficile BI/NAP1/027
strains were resistant to fluoroquinolones and sensitive to fidaxomicin,
metronidazole and vancomycin. Fidaxomicin had the most potent in vitro activity (MIC90 = 0.5 μg/ml) against the
BI/NAP1/027 strain. Twenty-six of 44 patients (59%) with the virulent strain were from a long-term care facility
(LTCF). Patients possessing the virulent strain from the LTCF had a mean APACHE
II score of 14.1 and a predicted death rate of 21.9%. Two-third of patients
were treated with metronidazole alone (mean APACHE II scores 9.6), and one-third required
oral vancomycin and metronidazole (mean APACHE II scores 14.1). There were no C.
difficile infection related deaths. C. difficile BI/NAP1/027, an epidemic strain, is the endemic strain at the
VA NJHCS, but no increased
mortality was seen with infection with this strain.