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In Recurrent C. difficile, the CRP Response to the Primary C. difficile Infection Predicts Whether the Same Strain or a Different Strain will Cause a Second Infection

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Abstract

Background

Clostridium difficile is the leading cause of antibiotic-associated diarrhoea and is associated with an increase in morbidity and mortality. There is a wide variance in disease severity with some patients suffering a single, self-limiting episode of diarrhoea while others suffer more intractable problems with recurrent attacks or toxic dilatation. Numerous different C. difficile ribotypes exist, some of which are considered hypervirulent. The magnitude of toxin production alone is not sufficient to explain the varying virulence of these ribotypes, suggesting the involvement of other mechanisms.

Methods

To test the same patient’s response to infection with different C. difficile ribotypes, we reviewed 45 patients who suffered two episodes of C. difficile infection and determined by ribotyping and MLVA whether the second episode was due to the same strain or a different strain.

Results

Patients harbouring a different strain had significantly higher C-reactive protein (CRP) responses on the first assessed infection (143 mg/L ± 20 vs. 55 ± 9.63, p = 0.0001) and a significantly lower CRP on reinfection (p = 0.048). Same strain patients had a non-significant increase in CRP response on second infection.

Conclusions

This suggests that the inflammatory response to C. difficile is determined by an interaction between host immunobiology, previous exposure and C. difficile strain.

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Acknowledgment

K.B. is grateful for support from the NIHR Biomedical Research Centre funding scheme.

Conflict of interest

None.

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Authors and Affiliations

  1. Department of Medicine, Imperial College London, London, W12 0NN, UK

    Kangni Chen, Naveen Setty & Jonathan Tyrrell-Price

  2. Department of Microbiology, Imperial College Healthcare NHS Trust, London, W12 0HS, UK

    Stephanie d’Arc & Kathy Bamford

  3. Department of Life Sciences, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK

    Stephanie d’Arc & Neil Fairweather

Authors
  1. Kangni Chen
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  2. Stephanie d’Arc
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  3. Naveen Setty
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  4. Kathy Bamford
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  5. Neil Fairweather
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  6. Jonathan Tyrrell-Price
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Corresponding author

Correspondence to Neil Fairweather.

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Chen, K., d’Arc, S., Setty, N. et al. In Recurrent C. difficile, the CRP Response to the Primary C. difficile Infection Predicts Whether the Same Strain or a Different Strain will Cause a Second Infection. Dig Dis Sci 58, 1683–1688 (2013). https://doi.org/10.1007/s10620-012-2534-4

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  • DOI: https://doi.org/10.1007/s10620-012-2534-4

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