Clostridium difficile Infection Caused by Binary Toxin–Positive Strains

we read the article by Bacci et al. in which they conclude that Clostridium difficile strains containing the binary toxin gene were associated with a higher case-fatality rate after 30 days, even when the analysis was stratified for PCR ribotype (1). Although this was an appealing conclusion, in our opinion the study was severely limited by selection bias and confounding by underlying diseases. First, in Danish patients with a C. difficile infection (CDI), isolates were characterized only if they were isolated during outbreaks or from patients with severe

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1. 1.

   Binary Toxin and Death after Clostridium difficile Infection · 2011

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