Division of Infectious Disease, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Clin Infect Dis. 2022 Jul 6;74(12):2142-2149. doi: 10.1093/cid/ciab826.
Stool toxin concentrations may impact Clostridioides difficile infection (CDI) severity and outcomes. We correlated fecal C difficile toxin concentrations, measured by an ultrasensitive and quantitative assay, with CDI baseline severity, attributable outcomes, and recurrence.
We enrolled 615 hospitalized adults (≥18 years) with CDI (acute diarrhea, positive stool nucleic acid amplification testing, and decision to treat). Baseline stool toxin A and B concentrations were measured by single molecule array. Subjects were classified by baseline CDI severity (4 scoring methods) and outcomes within 40 days (death, intensive care unit stay, colectomy, and recurrence).
Among 615 patients (median, 68.0 years), in all scoring systems, subjects with severe baseline disease had higher stool toxin A+B concentrations than those without (P < .01). Nineteen subjects (3.1%) had a severe outcome primarily attributed to CDI (group 1). This group had higher median toxin A+B (14 303 pg/mL [interquartile range, 416.0, 141 967]) than subjects in whom CDI only contributed to the outcome (group 2, 163.2 pg/mL [0.0, 8423.3]), subjects with severe outcome unrelated to CDI (group 3, 158.6 pg/mL [0.0, 1795.2]), or no severe outcome (group 4, 209.5 pg/mL [0.0, 8566.3]) (P = .003). Group 1 was more likely to have detectable toxin (94.7%) than groups 2-4 (60.5%-66.1%) (P = .02). Individuals with recurrence had higher toxin A+B (2266.8 pg/mL [188.8, 29411]) than those without (154.0 pg/mL [0.0, 5864.3]) (P < .001) and higher rates of detectable toxin (85.7% versus 64.0%, P = .004).
In CDI patients, ultrasensitive stool toxin detection and concentration correlated with severe baseline disease, severe CDI-attributable outcomes, and recurrence, confirming the contribution of toxin quantity to disease presentation and clinical course.
粪便毒素浓度可能会影响艰难梭菌感染（CDI）的严重程度和结果。我们通过超灵敏和定量检测法检测粪便艰难梭菌毒素浓度，并将其与 CDI 基线严重程度、归因结果和复发相关联。
我们纳入了 615 名患有 CDI（急性腹泻、粪便核酸扩增检测阳性和决定治疗）的住院成年患者（≥18 岁）。采用单分子阵列法检测基线粪便毒素 A 和 B 浓度。根据基线 CDI 严重程度（4 种评分方法）和 40 天内的结果（死亡、重症监护病房入住、结肠切除术和复发）对患者进行分类。
在 615 名患者中（中位年龄，68.0 岁），在所有评分系统中，基线疾病严重的患者粪便毒素 A+B 浓度均高于无严重疾病的患者（P<.01）。19 名患者（3.1%）因 CDI 主要归因于严重结局（组 1）。该组的中位毒素 A+B 浓度更高（14303 pg/mL[四分位距，416.0，141967]），高于仅因 CDI 导致结局的患者（组 2，163.2 pg/mL[0.0，8423.3]）、与 CDI 无关的严重结局患者（组 3，158.6 pg/mL[0.0，1795.2]）或无严重结局患者（组 4，209.5 pg/mL[0.0，8566.3]）（P=.003）。组 1 检测到毒素的可能性（94.7%）高于组 2-4（60.5%-66.1%）（P=.02）。复发患者的毒素 A+B 浓度更高（2266.8 pg/mL[188.8，29411]），高于无复发患者（154.0 pg/mL[0.0，5864.3]）（P<.001），且检测到毒素的比例更高（85.7%对 64.0%，P=.004）。
在 CDI 患者中，超灵敏粪便毒素检测和浓度与基线严重疾病、严重 CDI 归因结果和复发相关，证实了毒素数量对疾病表现和临床过程的影响。
