Nosocomial Clostridium difficile colonisation and disease.
To assess the risk of acquiring Clostridium difficile diarrhoea or colitis in patients colonised with C difficile, rectal swabs taken weekly for 9 weeks from patients with long-term (at least 7 days) hospital stays on three wards were cultured for C difficile. 60 (21%) of 282 patients were culture-positive for C difficile during their hospital stay, of whom 51 were symptom-free faecal excretors. C difficile diarrhoea developed in the other 9 patients; 2 were culture-positive for C difficile and had diarrhoea at the time of first culture, and 7 had diarrhoea or pseudomembranous colitis after 1-6 previously negative weekly rectal cultures. All patients with diarrhoea were on one ward, but symptom-free, excretors were found on all wards. HindIII chromosomal restriction endonuclease analysis (REA) of the C difficile isolates revealed 18 distinct types. All isolates from the patients with diarrhoea were one of two nearly identical REA types, B or B2. 26 of the 29 total B/B2 isolates were from patients on the same ward, which points to a nosocomial outbreak. The symptom-free excretors were not at increased risk of subsequent clinical illness.
Johnson
S
S
Department of Medicine, Veterans Administration Medical Center, Minneapolis, Minnesota 55417.
Clabots
C R
CR
Linn
F V
FV
Olson
M M
MM
Peterson
L R
LR
Gerding
D N
DN
D000368:Aged; D003013:Clostridium / Q000145:classification* / Q000302:isolation & purification; D003015:Clostridium Infections / Q000453:epidemiology / Q000235:genetics / Q000635:transmission*; D003428:Cross Infection / Q000453:epidemiology / Q000235:genetics / Q000635:transmission*; D004262:DNA Restriction Enzymes; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology*; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000209:etiology*; D005069:Evaluation Studies as Topic; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D000091402:Prohibitins; D011446:Prospective Studies; D015183:Restriction Mapping; D012307:Risk Factors; D012703:Serotyping / Q000379:methods; D013997:Time Factors
C000717331:PHB2 protein, human; D000091402:Prohibitins; D004262:DNA Restriction Enzymes