ArticleAnaerobe2018
Presence of multiple Clostridium difficile strains at primary infection is associated with development of recurrent disease.
Article in Anaerobe, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 30 citations in OpenAlex.
- Multi-strain Clostridioides difficile infection: Increased detection and clinical implications.The Journal of infection · 2026Article
- A Novel Technique to CharacterizebioRxiv : the preprint server for biology · 2025Article
- The analysis of the epidemic status and risk factors associated with different genotypes Clostridioides difficile mixed infection.BMC microbiology · 2025Article
- PREVENTION OF HEALTH CARE-ASSOCIATED INFECTIONS IN U.S. HEALTH SYSTEMS: HARNESSING THE GUT MICROBIOME TO COMBAT INFECTION.Transactions of the American Clinical and Climatological Association · 2025Review
- Genomic surveillance ofmBio · 2024Article
- Longitudinal genomic surveillance of carriage and transmission of Clostridioides difficile in an intensive care unit.Nature medicine · 2023Article
- Trends in and Risk Factors for Recurrent Clostridioides difficile Infection, New Haven County, Connecticut, USA, 2015-2020.Emerging infectious diseases · 2023Review
- Dysbiome and Its Role in Surgically Relevant Medical Disease.Surgical infections · 2023Review
- Capturing the environment of the Clostridioides difficile infection cycle.Nature reviews. Gastroenterology & hepatology · 2022Review
- The role of the gut microbiome in colonization resistance and recurrentTherapeutic advances in gastroenterology · 2022Review
- Analysis of Perioperative Risk Factors for Clostridium difficile Infection After a Colectomy.Cureus · 2021Article
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- Computational modeling of the gut microbiota reveals putative metabolic mechanisms of recurrent Clostridioides difficile infection.PLoS computational biology · 2021Article
- Epidemiology of community-acquired and recurrentTherapeutic advances in gastroenterology · 2021Review
- ggalluvial: Layered Grammar for Alluvial Plots.Journal of open source software · 2020Article
- Antimicrobial susceptibility and molecular characterisation using whole-genome sequencing ofAntimicrobial agents and chemotherapy · 2019Article
- Clostridioides difficile Whole-Genome Sequencing Reveals Limited Within-Host Genetic Diversity in a Pediatric Cohort.Journal of clinical microbiology · 2019Article
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Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
Abstract
Recurrence of Clostridium difficile infection (CDI) places a major burden on the healthcare system. Previous studies have suggested that specific C. difficile strains, or ribotypes, are associated with severe disease and/or recurrence. However, in some patients a new strain is detected in subsequent infections, complicating longitudinal studies focused on strain differences that may contribute to disease outcome. We examined ribotype composition over time in patients who did or did not develop recurrence to examine infection with multiple C. difficile ribotypes (mixed infection), during the course of infection. Using a retrospective patient cohort, we isolated and ribotyped a median of 36 C. difficile colonies from 61 patients (105 total samples) at initial infection, recurrence (a second case of CDI within 15-56 days of initial infection), and reinfection (a second case of CDI after 56 days of initial infection). We observed mixed infection in 78.6% of samples at initial infection in patients who went on to develop recurrence compared to 18.1% of patients who did not, and mixed infection remained associated with subsequent recurrence after adjusting for gender and prior antibiotic exposure (OR 3.5, 95% CI 1.3-9.4, P = .015). In patients who were sampled longitudinally (44 consecutive events in 32 patients), the dominant ribotype changed in 31.8% of consecutive samples and the newly dominant ribotype was not detected in prior samples from that patient. Our results suggest that mixed C. difficile infection is more prevalent than previously demonstrated and potentially a marker of susceptibility to recurrence.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.