ABSTRACT
Some strains of Clostridium difficile produce a binary toxin, in addition to the main C. difficile virulence factors (toxins A and B). There have been conflicting reports regarding the role of binary toxin and its relationship to the severity of C. difficile infection (CDI). Samples, isolates and clinical data were collected as part of a prospective multicentre diagnostic study. Clostridium difficile isolates (n = 1259) were tested by polymerase chain reaction (PCR) assay to detect binary toxin genes cdtA and cdtB. The PCR binary toxin gene results were compared with clinical severity and outcome data, including 30-day all-cause mortality. The 1259 isolates corresponded to 1083 different patients (October 2010 to September 2011). The prevalence of binary toxin positive strains was significantly higher in faecal samples with detectable toxin A/B than in those without toxin but that were positive by cytotoxigenic culture (26.3% vs. 10.3%, p < 0.001). The presence of binary toxin correlated moderately with markers of CDI severity (white cell count, serum albumin concentration and serum creatinine concentration). However, the risk ratio for all-cause mortality was 1.68 for binary toxin positive patients and patients were significantly less likely to survive if they had CDI caused by a binary toxin gene positive strain, even after adjusting for age (p < 0.001). The presence of binary toxin genes does not predict the clinical severity of CDI, but it is significantly associated with the risk of all-cause mortality.
Subject(s)
Clostridioides difficile/genetics , Clostridium Infections/microbiology , Endotoxins/genetics , Aged , Aged, 80 and over , Bacterial Toxins/genetics , Biomarkers , Cause of Death , Clostridioides difficile/pathogenicity , Clostridium Infections/diagnosis , Clostridium Infections/epidemiology , Female , Humans , Kaplan-Meier Estimate , Length of Stay , Male , Middle Aged , Severity of Illness IndexABSTRACT
Prevention and management of Clostridium difficile infection (CDI) can be improved by rapid and reliable diagnostics. The Vidas C. difficile glutamate dehydrogenase assay had performance comparable to that of the Quik Chek-60 assay (overall agreement, 95%) and a sensitivity of >93%; thus, it is suitable as the first test in two-stage algorithms for a CDI diagnosis.
Subject(s)
ATP-Binding Cassette Transporters/genetics , Bacterial Proteins/genetics , Bacterial Typing Techniques/methods , Clostridioides difficile/isolation & purification , Enzyme-Linked Immunosorbent Assay/methods , Feces/microbiology , Polymerase Chain Reaction/methods , Adolescent , Adult , Child , Child, Preschool , Clostridioides difficile/genetics , Culture Media , Enterocolitis, Pseudomembranous/diagnosis , Enterocolitis, Pseudomembranous/microbiology , Humans , Infant , Infant, Newborn , Male , Middle Aged , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
This article discusses self psychology as a theory of personality development and conceptual framework for diagnosing psychopathology. It seeks to show how specific components of this theory, including selfobjects, bipolar self, mirroring, tension arc, and nuclear self, can be compared with the "curative factors" of group psychotherapy, as presented by Yalom (1975). These include altruism, group cohesiveness, universality, interpersonal learning, guidance, and family reenactment. Existing literature is used to explain both theories and develop their synthesis.
