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. 2012 Jan;50(1):142-4.
doi: 10.1128/JCM.05177-11. Epub 2011 Nov 9.

Clostridium difficile mixed infection and reinfection

David W Eyre  1 , A Sarah Walker, David Griffiths, Mark H Wilcox, David H Wyllie, Kate E Dingle, Derrick W Crook, Tim E A Peto
Affiliations

Clostridium difficile mixed infection and reinfection

David W Eyre et al. J Clin Microbiol. 2012 Jan.

Abstract

Isolates from consecutive Clostridium difficile infection (CDI) fecal samples underwent multilocus sequence typing. Potential reinfections with different genotypes were identified in 88/560 (16%) sample pairs taken 1 to 1,414 days (median, 24; interquartile range [IQR], 1 to 52 days) apart; odds of reinfection increased by 58% for every doubling of time between samples. Of 109 sample pairs taken on the same day, 3 (3%) had different genotypes. Considering samples 0 to 7 days apart as the same CDI, 7% of cases had mixed infections with >1 genotype.

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Figures

Fig 1
Fig 1
Chance of consecutive C. difficile isolates having no sequence types (STs) in common according to time between samples. (A) Observed data, categorizing time between consecutive fecal samples into approximate quartiles. (B) Fitted logistic regression model. Data split by whether the first ST is the most common ST-1/PCR-ribotype-027 or not, because reinfection with a different lineage of the same ST is more likely where the first ST is relatively common, e.g., ST-1. Therefore, the estimated reinfection rate where the first ST in a pair is ST-1 is likely underestimated. Best-fitting fractional polynomial model (8) included log (days between consecutive samples).
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