Binary toxin and death after Clostridium difficile infection

Sabrina Bacci, Kåre Mølbak, Marianne Kirstine Kjeldsen, Katharina E. P. Olsen

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This study compared 30-day case-fatality rates for patients infected with Clostridium difficile possessing genes for toxins A and B without binary toxin (n = 212) with rates for patients infected with C. difficile possessing genes for A, B and binary toxin. The latter group comprised patients infected with strains of PCR ribotype 027 (CD027, n = 193) or non-027 (CD non-027, n = 72). Patients with binary toxin had higher case-fatality rates than patients without binary toxin, in univariate analysis (relative risk (RR) 1.8, 95% confidence interval (CI) 1.2–2.7) and multivariate analysis after adjustment for age, sex and geographic region (RR 1.6, 95% CI 1.0–2.4). Similar case-fatality rates (27.8%, 28.0%) were observed for patients infected with CD027 or CD non-027. Binary toxin either is a marker for more virulent C. difficile strains or contributes directly to strain virulence. Efforts to control C. difficile infection should target all virulent strains irrespective of PCR ribotype.
Original languageEnglish
JournalEmerging Infectious Diseases (Print Edition)
Issue number6
Publication statusPublished - 2011
Externally publishedYes


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