W1278 Clostridium difficile NaP-1 Strain Is Not Associated with Severe Disease in a Non-Epidemic Setting

Clostridium difficileInfection (CDI) Severity and Outcome among Patients Infected with the NAP1/BI/027 Strain in a Non-Epidemic Setting

“…Older age has been reported as a risk factor for the development of CDI caused by the NAP1 strain in epidemic and nonepidemic settings. 10,12,16 In the present study, patients in the NAP1 group were admitted from a nursing home prior to hospitalization at a greater frequency than patients in the non-NAP1 group. An investigation into the prevalence of asymptomatic carriage of the C. difficile among long-term care facility residents in 1 institution showed that~50% of the residents were asymptomatic fecal carriers of toxin-producing C. difficile strains; 37% of these strains were noted to be NAP1.…”

“…1,2,[12][13][14][15] Our single-center, retrospective, case-control study conducted during a non-epidemic CDI time period observed a NAP1 incidence of 18% among all CDI stool specimens. The incidence of CDI caused by the NAP1 strain in our study is lower than the rate reported among 25 hospitals in the Chicago area in 2009 (61%).…”

“…17 A prospective study investigating the frequency of C. difficile infection and disease severity outcomes showed that a greater number of patients diagnosed with CDI caused by the NAP1 strain had C. difficile symptoms developing at an outside facility (defined as outside hospital, rehabilitation facility, or nursing home) compared with home (P = .0097) or the study hospital (P = .0016) when compared with patients diagnosed with CDI caused by a non-NAP1 strain. 12 Patients residing in a nursing home may be at risk for developing CDI caused by the NAP1 strain due to age, previous hospitalization, comorbidities, differing infection control practices at long-term care facilities and hospitals, and/or exposure to antibiotics. 12,[18][19][20] Prior use of antibiotics, specifically fluoroquinolones, was reported as a risk factor for the development of CDI caused by the NAP1 strain.…”

“…12 Patients residing in a nursing home may be at risk for developing CDI caused by the NAP1 strain due to age, previous hospitalization, comorbidities, differing infection control practices at long-term care facilities and hospitals, and/or exposure to antibiotics. 12,[18][19][20] Prior use of antibiotics, specifically fluoroquinolones, was reported as a risk factor for the development of CDI caused by the NAP1 strain. 10,16 In our study, there was no difference between study groups in antibiotic use 3 months prior to diagnosis of CDI.…”

“…12,[21][22][23][24] Clinical studies have shown that CDI caused by the NAP1 strain are associated with a decreased cure rate, increased severity of disease, and disease relapse. 22,23 Studies conducted in a nonepidemic setting reported no difference in disease severity or mortality among patients diagnosed with CDI caused by the NAP1 strain when compared with patients diagnosed with the non-NAP1 strain.…”