| Sumario: | Background: Clostridium difficile infections caused by the NAP1/B1/027 strain are more severe,
difficult to treat, and frequently associated with relapses.
Methods: A case–control study was designed to examine a C. difficile infection (CDI) outbreak
over a 12-month period in a Mexican hospital. The diagnosis of toxigenic CDI was confirmed
by real-time polymerase chain reaction, PCR (Cepheid Xpert C. difficile/Epi).
Results: During the study period, 288 adult patients were evaluated and 79 (27.4%) patients
had confirmed CDI (PCR positive). C. difficile strain NAP1/B1/027 was identified in 31 (39%) of
the patients with confirmed CDI (240 controls were included). Significant risk factors for CDI
included any underlying disease (p < 0.001), prior hospitalization (p < 0.001), and antibiotic
(p < 0.050) or steroid (p < 0.001) use. Laboratory abnormalities included leukocytosis (p < 0.001)
and low serum albumin levels (p < 0.002). Attributable mortality was 5%. Relapses occurred
in 10% of patients. Risk factors for C. difficile NAP1/B1/027 strain infections included prior
use of quinolones (p < 0.03).
Risk factors for CDI caused by non-027 strains included chronic cardiac disease (p < 0.05),
chronic renal disease (p < 0.009), and elevated serum creatinine levels (p < 0.003). Deaths and
relapses were most frequent in the 027 group (10% and 19%, respectively).
Conclusions: C. difficile NAP1/BI/027 strain and non-027 strains are established pathogens in
our hospital. Accordingly, surveillance of C. difficile infections is now part of our nosocomial
prevention program.
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