Perfil evolutivo e estudo ribotípico da infecção por Clostridioides (Clostridium) difficile em coorte de pacientes com diarreia internados no Hospital das Clínicas da UFMG

Abstract

Introduction: Clostridioides difficile infection (CDI) is the main cause of health careassociated diarrhea. The emergency of hypervirulent strains since the 2000s in developed countries has been responsible for the increasing incidence, severity and mortality related to the infection and has motivated the surveillance studies, aiming for better control and management of this disease. Objectives: assess the CDI evolutionary profile and characterize its ribotypes. Patients and methods: 65 patients whose diagnosis was confirmed by testing for toxins A and B and toxigenic culture performed in stool specimens were included. 44 bacterial strains were subjected to ribotyping and binary toxin gene search by the polymerase chain reaction. The patients were characterized in relation to demographics, clinical, laboratory aspects and severity criteria. Results: 34 patients were male and 31 were female. The age median was 59 (20-87) years old. There were 16 (24,6%) deaths during the period of hospitalization. The median of the Charlson Comorbidity Index was 4 (0-15). The score greater or equal to 8 was present in 16,9% of the sample (11 patients). Among the comborbities, the neoplasms were the most prevalent, present in 29 patients (44.6%), followed by cardiovascular diseases, in 23 patients (35.4%). Fourteen patients had been transplanted and only one patient had not been treated with antibiotics in the three months preceding the diagnosis. Recurrence was associated with the Charlson Comorbidity Index > 7 (OR = 24.52; IC 95% 1.67 – 360.22). The longer length of hospitalization was related to multiple antibiotics treatments (OR = 1.64; IC 95% 1.29 – 1.82) and to the need for enteral nutrition (OR = 1.66; IC 95% 1.36 – 1.82). The period of hospitalization between the CDI diagnosis and the hospital discharge was longer among the patients with multiple antibiotic treatments (OR = 1.58; IC 95% 1.13 – 1.80), new antibiotic after diagnosis (OR = 1.75; IC 95% 1.48 – 1.88) and need of intensive care unit (OR = 1.57; IC 95% 1.18 – 1.78). The ATLAS score (OR = 1.76; CI 95% 1.08 – 2.86) and the non improvement of the diarrhea (OR = 1.08; CI 95% 1.008 – 1.747) were related to a higher mortality. Eight binary toxin positive strains were identified. The most common ribotype (RT) was the 106 (43.2%), followed by 014/020 (9.1%), with 20 different ribotypes being identified. RT027 has not been isolated. The identification of the binary toxin and the type of C. difficile did not correlate with the studied outcomes. Conclusion: CDI was present in the samples of complex patients and carriers of severe diseases. Factors associated with a higher chance of death, longer hospitalization and recurrence were identified. A higher diversity of ribotypes was observed, although the RT106 was the most prevalent. The identification of the binary toxin and the type of C. difficile did not correlationate with the studied outcomes.