Growth Patterns of Clostridium difficile – Correlations with Strains, Binary Toxin and Disease Severity: A Prospective Cohort Study

Abstract

A broad spectrum of symptoms has been associated with C. difficile infection (CDI). Several studies indicate that toxin-production correlates with growth rates of C. difficile. This study aimed to correlate growth rates of C. difficile with disease severity and strain characteristics. From 01/2003 to 10/2011, strains from a prospective cohort of all inpatients with CDI at the University Hospital Basel, Switzerland were analyzed regarding binary toxin, presence of the tcdC deletion and ribotype. Isothermal microcalorimetry was performed to determine growth rates, quantified by the Gompertz function. Ordered logistic regression models were used to correlate disease severity with strain features and clinical characteristics. Among 199 patients, 31 (16%) were infected with binary toxin-producing strains, of which the tcdC gene-deletion nt117 was detected in 9 (4%). Disease severity was classified as mild in 130 patients (65.3%), as severe in 59 patients (29.7%) and as severe/complicated in 10 patients (5.0%). Growth rates were inversely associated with disease severity in univariable (OR 0.514, 95%CI 0.29–0.91, p = 0.023) and multivariable analyses (OR 0.51, 95%CI 0.26–0.97, p = 0.040). While none of the strain characteristics such as presence of the tcdC gene deletion or binary toxin predicted CDI severity, growth rates were inversely correlated with disease severity. Further investigations are needed to analyze growth-regulators and respective correlations with the level of toxin production in C. difficile, which may be important determinants of disease severity.

Comparison of isothermal microcalorimetry and BACTEC MGIT960 for the detection of the metabolic activity ofMycobacterium tuberculosisin sputum samples

“…However, specific growth rate determination might provide valuable additional data complementing the calorimetric detection by potentially indicating more aggressive strains (higher specific growth rates) with higher pathogenicity or on the contrary strains generating larger amounts of persister cells (with lower specific growth rates). Such links between growth rate and pathogenicity have already been described for pathogens such as Clostridium (Tschudin‐Sutter et al ) and E. coli (Gordon and Riley ). However, additional studies will be required to further investigate this observation.…”

Incidence, risk factors, and outcome of Clostridioides difficile infection following urological surgeries

“…In radical cystectomy, the higher incidence of CDI may be related to the complex nature of the operation, bowel preparation, prolonged hospitalization, use of perioperative broader spectrum antibiotics, and intestinal diversion. Approximately 76% of postoperative CDI in the United States occur after hospital discharge, and the incidence of CDI may be linked to the observation that slower growth rates correlate with increased disease severity [ 27 , 28 ]. Initiatives to reduce CDI rates with judicious antibiotic use are warranted, and we identified potentially modifiable factors that were associated with CDI after radical cystectomy including length of operation and blood loss/transfusion.…”

Isolation of nativeClostridiafor utilization of agroindustrial cherry waste into butanol

“…At this point, the strains were allowed to grow until an optical density (OD) close to 0.6 at 600 nm was achieved. This with the aim of working in the exponential phase …”

“…This with the aim of working in the exponential phase. 21 Then 1 mL of the activated strains was used for its growing in 15 mL of medium P2 and another 1 mL was used within the ChW medium. Both medium were set at pH 6.0 and were left during 7 days at 35°C, were incubated at 200 rpm in an orbital incubator shaker.…”