Clinical Outcomes of Patients With Clostridium Difficile Associated Disease Attributable to Diverse tcdC Genotypes
Clinical Outcomes of Patients With Clostridium Difficile Associated Disease Attributable to Diverse tcdC Genotypes
The purpose of the study is to establish the clinical disease outcomes and features of CDAD
 associated with variant tcdC genotypes. Two hypotheses are to be tested in this study:

 1. Severe CDAD and tcdC truncation:

 Severe CDAD (defined by death and/or colectomy or secondary endpoints) is associated
 with severe truncations (> 6 amino acid residues) in TcdC, a negative regulator of toxin
 A/B production.

 2. Disease in low risk populations (patients never exposed to health care facilities and/or
 patients who never received antibiotics) of any severity is attributable to strains of
 C. difficile with severe tcdC truncation.
The following information will be collected: age, sex, occupation, hospital location at the
 time of positive culture (ER, medical ward, ICU etc), prior hospitalization, receipt of
 outpatient dialysis, home care or other regular medical care (eg, outpatient chemotherapy),
 date of specimen collection, presence of invasive devices, receipt of antibiotics, including
 their type and whether they were adequate for the resistance profile of the organism, prior
 positive microbiologic cultures, time and location of positive cultures, underlying diseases
 and severity of illness, presence of urinary or intravascular devices, recent
 immunomodulative therapies or radiation therapy, physical exam findings, laboratory and
 radiographical data, antimicrobial usage within 6 months of onset of the infection,
 microbiological data and resistance patterns, choice of antibiotics once organism identified,
 bacteriological outcomes, laboratory results, demographic information, medications, clinical
 outcome,gender, height, weight, ethnicity, past medical history and outcomes. We will collect
 information retrospectively.
Inclusion Criteria:

 -  All patients who have confirmed CDAD, confirmed by testing at UPMC's clinical
 microbiology lab in March 1, 2001- December 31, 2005 for C. difficile by stool toxin
 test with subsequent positive culture for the organism from inpatients/outpatients at
 UPMC Presbyterian-Montefiore, from WPIC inpatient units, from ER visits at the
 Presbyterian University Hospital emergency department, and from clinics closely
 affiliated with UPMC Presbyterian (medical and surgical clinics in Falk Clinic, the 9
 South Montefiore internal medicine clinic, the geriatrics clinic in Montefiore, and
 the digestive disorders center (GI clinic on 3rd floor of PUH).