ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2012
Clostridium difficile ribotype does not predict severe infection.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 108 papers, 1 of them a synthesis that pooled it.
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Who cites it
108 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Risk factors for recurrence, complications and mortality in Clostridium difficile infection: a systematic review.PloS one · 2014Pooled it
- Antimicrobial susceptibility and ribotypes of Clostridium difficile isolates from a Phase 2 clinical trial of ridinilazole (SMT19969) and vancomycin.The Journal of antimicrobial chemotherapy · 2018Trial
- Effect of the ribotype 027 strain on Clostridioides difficile infection outcomes and recurrence in the Veterans Affairs healthcare system: a propensity scores matching study.BMC infectious diseases · 2026Article
- Clinical outcomes of toxin-positive versus toxin-negative/NAAT-positive Clostridioides difficile infection in South Korea: a single-center retrospective cohort study.BMC infectious diseases · 2026Article
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- Epidemiology and genetic characteristics ofPeerJ · 2025Article
- Genomic and phenotypic studies amongMicrobiology spectrum · 2024Article
- "Antibiotics (Basel, Switzerland) · 2024Article
- Genomic surveillance ofmBio · 2024Article
- Molecular epidemiological analyses ofHeliyon · 2023Article
- Virulence and genomic diversity among clinical isolates of ST1 (BI/NAP1/027) Clostridioides difficile.Cell reports · 2023Article
- Insights into the Evolving Epidemiology ofAntibiotics (Basel, Switzerland) · 2023Review
- Virulence and genomic diversity among clinical isolates of ST1 (BI/NAP1/027)bioRxiv : the preprint server for biology · 2023Article
- Article
- An Update onToxins · 2022Review
- Comparison of clinical severity, genotype and toxin gene expression of binary toxin-producingAccess microbiology · 2022Article
- Risk Factors of SevereFrontiers in microbiology · 2022Article
- Diagnostic Methods ofAntibiotics (Basel, Switzerland) · 2021Article
- Article
- Laboratory markers predictive of fulminantInfection prevention in practice · 2021Article
48 more citing papers are in PubMed but not listed here.
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Authors and funding
16 authors.
Funding
Abstract
backgroundStudies of Clostridium difficile outbreaks suggested that certain ribotypes (eg, 027 and 078) cause more severe disease than other ribotypes. A growing number of studies challenge the validity of this hypothesis.
methodsWe conducted a cross-sectional study of C. difficile infection (CDI) to test whether ribotype predicted clinical severity when adjusted for the influence of other predictors. Toxigenic C. difficile isolates were cultured from stool samples, screened for genes encoding virulence factors by polymerase chain reaction (PCR) and ribotyped using high-throughput, fluorescent PCR ribotyping. We collected data for 15 covariates (microbiologic, epidemiologic, and laboratory variables) and determined their individual and cumulative influence on the association between C. difficile ribotype and severe disease. We then validated this influence using an independent data set.
resultsA total of 34 severe CDI cases were identified among 310 independent cases of disease (11.0%). Eleven covariates, including C. difficile ribotype, were significant predictors of severe CDI in unadjusted analysis. However, the association between ribotypes 027 and 078 and severe CDI was not significant after adjustment for any of the other covariates. After full adjustment, severe cases were significantly predicted only by patients' white blood cell count and albumin level. This result was supported by analysis of a validation data set containing 433 independent CDI cases (45 severe cases; 10.4%).
conclusionsRibotype is not a significant predictor of severe CDI when adjusted for the influence of any other variables separately or in combination. White blood cell count and albumin level are the most clinically relevant predictors of severe CDI cases.
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