The prognostic value of toxin B and binary toxin in Clostridioides difficile infection

Abstract

To study the association between detection of the Clostridioides difficile gene encoding the binary toxin (CDT) and direct detection of toxinB (TcdB) from feces with the appearance of serious disease, complications, or recurrence in a prospective series of cases. A total of 220 confirmed cases were included, using a two-step algorithm: an initial study to detect the enzyme, glutamate dehydrogenase (GDH), followed, in cases of positivity, by detection of the tcdB. tcdB-positive patients were investigated for the presence of CDT and TcdB. Outcome variables were severe disease, the modified Illinois C. difficile infection (CDI) prognostic risk index (ZAR score), the appearance of complications (need for colectomy, CDI-related death, or toxic megacolon) and recurrence. Patients who tested positive for the presence of TcdB in feces were found to have greater disease severity than those who tested negative, with a ZAR score of 35.4% vs. 23% (p = .048), a higher recurrence rate (14.6% vs. 5.9%, p = .032), and a tendency for higher number of complications (20.7% vs. 11.5%), although without reaching statistical significance (p = .053). When presence of CDT was analyzed, higher frequencies of severe disease (39.2% vs. 21.2%, p = .005), complications and recurrence (21.6% vs. 10.9%, p = .037 and 14.9% vs. 5.8%, p = .029; respectively) were observed in patients where CDT was detected. TcdB and CDT act as prognostic markers of the appearance of serious disease, complications or recurrence in cases of CDI. Simultaneous detection of both markers, TcdB and CDT, had a greater impact on the prognosis than when they were detected separately.

Prognostic factors for severe and recurrent Clostridioides difficile infection: a systematic review

“…The search for prognostic factors for sCDI yielded 1242 references; 126 studies were assessed in more detail and 76 were included for analysis [20,24,25,29,; twelve more studies retrieved from cross-references were also included [111][112][113][114][115][116][117][118][119][120][121][122] resulting in 88 studies for final analysis (Figure 1). The search for prognostic factors for rCDI yielded 1104 references; 105 studies were assessed in more detail and 36 were included for analysis [9, 10, 12-15, 103, 110, 123-150] as were seven studies from cross-references.)…”

“…Furthermore, seven studies assessed C. difficile binary toxin as risk factor for sCDI [47,83,92,95,118,120,122]. Of these, three identified C. difficile binary toxin as a risk factor for sCDI in univariate analysis, and only 1/1 study in multivariate analysis.…”

GRADING prognostic factors for severe and recurrentClostridioides difficileinfection: expected and unexpected findings. A systematic review

“…The search for prognostic factors for sCDI yielded 1242 references; 126 studies were assessed in more detail and 76 were included for analysis (20,24,25,29,; twelve more studies retrieved from cross-references were also included (110)(111)(112)(113)(114)(115)(116)(117)(118)(119)(120)(121) resulting in 88 studies for final analysis (Figure 2). The search for prognostic factors for rCDI yielded 1104 references; 105 studies were assessed in more detail and 36 were included for analysis (9, 10, 12-15, 102, 109, 122-149) as were seven studies from cross-references.)…”

“…One study found that NAP1/027 was more prevalent in patients with mild disease compared to patients with sCDI (44). Furthermore, seven studies assessed C. difficile binary toxin as risk factor for sCDI (45,82,91,94,117,119,121). Of these, three identified C. difficile binary toxin as a risk factor for sCDI in univariate analysis, and only 1/1 study in multivariate analysis.…”

Characterization and Pharmacological Inhibition of the Pore-Forming Clostridioides difficile CDTb Toxin

“…Although the large Rho/Ras-glycosylating toxins TcdA and TcdB are regarded as the main virulence factors of C. difficile, increasing numbers of strains have been identified that additionally release CDT [1,9,45,46]. The role of CDT as a virulence factor is still under debate.…”