Contrary to earlier findings that suggested Ribotype 027 was more harmful than other Clostridium difficile  strains, more recently-published data suggest that no strains are any more harmful than others.

The data published in Infection Control & Hospital Epidemiology suggest that clinical severity markers of CDI,such as white blood cell count and albumin level, are more important predictors of severe outcomes.

This multicenter observational cohort study used data from more than 700 patients at seven hospitals in the Houston, TX area to assess disease severity at presentation and the clinical outcomes of patients with varying C. difficile strains. 

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The researchers conducted epidemiologic strain typing of C. difficile to identify both the prevalence of different strains, as well as the effect of distinct strains on disease severity and patient outcomes.

Although C. difficile R027 was the most prevalent strain associated with severe onset of the disease, it was found to not be any more likely to cause severe outcomes than other C. difficile strains. 

However, the researchers noted that continued use of non-C. difficile antibiotics was a strong predictor of severe CDI outcomes in all strains. The continued use of other antibiotics has previously been associated with prolonged diarrhea and CDI treatment failure.

Strain typing remains a valuable source of information for tracking emergence of different strains and may potentially influence treatment decisions, the researchers noted in a press release about the study, but clinical severity markers appear to be more important predictors for the determining the severity of CDI patient outcomes.


1. Samuel L. Aitken SL, et al. ICHE. 2015; doi: