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PubMed1999

Incidence of Clostridium difficile infection: a prospective study in an Indian hospital.

Clostridium difficile is the commonest cause of hospital-acquired diarrhoea. A prospective study comprising of 156 patients and 54 healthy controls was undertaken to assess C. difficile associated diarrhoea (CDAD) incidence in an Indian hospital. Methods used included C. difficile culture and enzyme linked immunosorbent assay (ELISA) for Toxin A. Attempts were made to type isolates by antibiogram and SDS-PAGE. Of the 210 stool samples tested, 12 gave positive results in at least one assay. Of these, 11 were positive by the ELISA method, eight by culture, and seven by both methods. Neither the organisms nor the toxin was found in healthy controls or neonates. The average disease incidence of CDAD estimated by using both methods was 15%. Two antibiotypes of the isolates were obtained and of the isolates characterized by SDS-PAGE, two had identical patterns. This study shows that CDAD is an emerging problem in Indian hospitals. Monitoring should enable the development and implementation of policies and procedures that minimize the risk of this nosocomial pathogen.

Adolescent↗
PubMed2004

Molecular epidemiology of hospital-associated and community-acquired Clostridium difficile infection in a Swedish county.

All episodes of Clostridium difficile associated diarrhea (CDAD) diagnosed in a defined population of 274,000 including one tertiary and two primary hospitals and their catchment areas were studied during 12 months. The annual CDAD incidence in the county was 97 primary episodes per 100,000, and 78% of all episodes were classified as hospital associated with a mean incidence of 5.3 (range, 1.4 to 6.5) primary episodes per 1,000 admissions. The incidence among hospitalized individuals was 1,300-fold higher than that in the community (33,700 versus 25 primary episodes per 100,000 persons per year), reflecting a 37-fold difference in antibiotic consumption (477 versus 13 defined daily doses [DDD]/1,000 persons/day) and other risk factors. Three tertiary hospital wards with the highest incidence (13 to 36 per 1,000) had CDAD patients of high age (median age of 80 years versus 70 years for other wards, P < 0.001), long hospital stay (up to 25 days versus 4 days), or a high antibiotic consumption rate (up to 2,427 versus 421 DDD/1,000 bed days). PCR ribotyping of C. difficile isolates available from 330 of 372 CDAD episodes indicated nosocomial acquisition of the strain in 17 to 27% of hospital-associated cases, depending on the time interval between index and secondary cases allowed (2 months or up to 12 months), and only 10% of recurrences were due to a new strain of C. difficile (apparent reinfection). In other words, most primary and recurring episodes were apparently caused by the patient's endogenous strain rather than by one of hospital origin. Typing also indicated that a majority of C. difficile strains belonged to international serotypes, and the distribution of types was similar within and outside hospitals and in primary and relapsing CDAD. However, type SE17 was an exception, comprising 22% of hospital isolates compared to 6% of community isolates (P = 0.008) and causing many minor clusters and a silent nosocomial outbreak including 36 to 44% of the CDAD episodes in the three high-incidence wards.

Clostridioides difficile↗
PubMed1995

Usefulness of culture in the diagnosis of Clostridium difficile infection.

Between January and April 1993, culture for Clostridium difficile and a faecal cytotoxin assay were performed on 500 selected specimens. Isolates from culture-positive patients from whom faecal samples were cytotoxin negative were also examined in vitro for cytotoxin production. The significance of a positive culture result in the absence of faecal cytotoxin was assessed. Forty-one of the 500 specimens were toxin positive. In only 25 of these was Clostridium difficile examination specifically requested. Six of nine culture-positive cytotoxin-negative patients (11 specimens) had recently received antibiotics. In four of these, Clostridium difficile was considered to be of possible clinical significance. Culture and in vitro determination of toxin production of isolates may aid in the diagnosis of some additional cases, but cytotoxin detection remains the single optimal routine laboratory method for diagnosis.

Adult↗
PubMed1991

Correlation of immunoblot type, enterotoxin production, and cytotoxin production with clinical manifestations of Clostridium difficile infection in a cohort of hospitalized patients.

To determine whether strain-specific differences in immunoblot type, enterotoxin production, or cytotoxin production correlated with clinical presentation of Clostridium difficile infection, we evaluated isolates obtained from 428 prospectively studied hospitalized patients. Of 99 isolates available for immunoblot typing, 61 were recovered from asymptomatic carriers and 38 were from patients with C. difficile-associated diarrhea. Of 17 immunoblot types, the seven types comprising the majority of isolates (82 of 99; 83%) were variably associated with disease. Neither the presence of cytotoxin in the stool nor the production of cytotoxin or enterotoxin by isolates in vitro was significantly different for symptomatic versus asymptomatic patients. Selected host factors were more predictive of symptomatic disease than was the specific infecting C. difficile strain. These results suggest that variations in the clinical severity of C. difficile infection in different patients are not solely strain-specific phenomena related to immunoblot type or to the production of cytotoxin or enterotoxin.

Antibodies, Bacterial↗
PubMed1997

Clostridium difficile infection in obstetric and gynecologic patients.

We reviewed hospital records of women on the obstetrics and gynecologic services with a diagnosis of antibiotic-associated diarrhea, pseudomembranous colitis, or Clostridium difficile infection to better characterize the incidence and course of women with C difficile infection. Cases were included if there was identification of C difficile by culture or toxin or endoscopic verification of pseudomembranous colitis. Between January 1985 and June 1995, there were 74,120 admissions to the obstetrics and gynecology services at two tertiary level hospitals. Eighteen women were found to have documented C difficile infection (0.02%)--3 from the obstetric services, 10 from the benign gynecologic services, and 5 from the gynecologic/oncology services. Diarrhea developed from 2 days to 30 days after antibiotics had been given (mean, 10 days). Nine patients had fever, six had nausea and vomiting, and five had abdominal pain. Antimicrobial agents given before infection included cephalexin, cefoxitin, imipenem, ciprofloxacin, trimethoprim/sulfamethoxazole, ampicillin, gentamicin, and clindamycin. All patients were treated successfully with inpatient antimicrobial agents-15 with metronidazole and 3 with vancomycin. There was one possible recurrence.

Abdominal Pain↗
PubMed1992

Enteric Clostridium perfringens infection associated with parvoviral enteritis in dogs: 74 cases (1987-1990).

Parvovirus infection was confirmed by fluorescent antibody staining of or viral isolation from specimens of small intestine in 181 (17%) of 1,110 dogs necropsied between July 1, 1987 and Dec 31, 1990. Clostridium perfringens was isolated from 74 (69%) of 108 dogs with parvovirus infection from which specimens of jejunum also had been obtained for culture of anaerobic bacteria. Gram-positive bacilli in association with focal to diffuse necrosis of the superficial portions of the villi were observed in histologic sections of specimens of small intestine from 56 (98%) of 57 dogs from which parvovirus and C perfringens had been identified. These findings indicate that C perfringens frequently proliferates in dogs with parvovirus infection.

Animals↗