Dataset Information

Eosinopenia and Binary Toxin Increase Mortality in Hospitalized Patients With Clostridioides difficile Infection.

ABSTRACT:

Background

Patients with Clostridioides difficile infection (CDI) with either eosinopenia or infected with a binary toxin strain have increased likelihood of mortality. However, the relationship between binary toxin and eosinopenia to synergistically increase mortality has not been studied in humans. We hypothesized that patients with CDI due to binary toxin strains and concomitant peripheral eosinopenia would have a higher likelihood of inpatient mortality.

Methods

This multicenter, retrospective cohort study included adult patients with CDI of known ribotypes stratified by eosinopenia, defined as an absence of eosinophils in the peripheral blood (Houston cohort). The primary outcome was inpatient mortality. Results were supported by a separate national cohort of veterans with CDI (Veterans' cohort).

Results

In the Houston cohort, a total of 688 patients from 13 institutions in 6 cities were included. Of these, 132 (19%) had an eosinophil count of 0.0 cells/µL (0.0 cells*10⁹/L) and 109 (16%) were infected with a binary toxin strain. After adjusting for covariates, the combination of eosinopenia and infection with a binary toxin strain was an independent predictor of inpatient mortality (odds ratio [OR], 7.8; 95% confidence interval [CI], 1.9-33.2; P = .005). In the separate Veterans' cohort (n = 790), this combination was also a significant predictor of inpatient mortality (OR, 6.1; 95% CI, 1.5-23.9; P = .009).

Conclusions

In conclusion, the combination of eosinopenia and CDI due to a binary toxin strain was correlated with increased mortality in hospitalized patients from 2 independent cohorts. Prospective studies should further study this important subset of patients at the time of CDI diagnosis.

SUBMITTER: Carlson TJ

PROVIDER: S-EPMC6979314 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Eosinopenia and Binary Toxin Increase Mortality in Hospitalized Patients With <i>Clostridioides difficile</i> Infection.

Carlson Travis J TJ Endres Bradley T BT Le Pham Julie J Gonzales-Luna Anne J AJ Alnezary Faris S FS Nebo Kimberly K Miranda Julie J Lancaster Chris C Bassères Eugénie E Begum Khurshida K Alam M Jahangir MJ Reveles Kelly R KR Garey Kevin W KW

Open forum infectious diseases 20200104 1

<h4>Background</h4>Patients with <i>Clostridioides difficile</i> infection (CDI) with either eosinopenia or infected with a binary toxin strain have increased likelihood of mortality. However, the relationship between binary toxin and eosinopenia to synergistically increase mortality has not been studied in humans. We hypothesized that patients with CDI due to binary toxin strains and concomitant peripheral eosinopenia would have a higher likelihood of inpatient mortality.<h4>Methods</h4>This mu ...[more]

PMID: 31993458

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