title: Characterization of a nosocomial Clostridium difficile outbreak by using plasmid profile typing and clindamycin susceptibility testing.
abstract: The mean number of cases of Clostridium difficile diarrhea at the Minneapolis Veterans Administration Medical Center increased to 17.3 per month in June-August 1985, compared with 7.1 per month in the previous 17 mo. Plasmid profiles and clindamycin susceptibility were used as markers to evaluate the increase in cases. Ninety clindamycin-resistant and 22 clindamycin-susceptible isolates of C. difficile from 1985 were examined for plasmids. A clindamycin-resistant organism contained a cryptic plasmid of 3.1 kilobases (kb). None of the clindamycin-susceptible isolates contained the 3.1-kb plasmid, as compared with 40 of 90 clindamycin-resistant isolates (P less than .005). Restriction endonuclease digestion and Southern blot hybridization were used to confirm the identity of the 3.1-kb plasmid between strains. Isolates retained clindamycin resistance after plasmid curing. It could not be determined if the organism responsible was an indigenous C. difficile strain that acquired a plasmid or was a new strain introduced from outside the hospital.
authors.affiliation: Department of Medicine, Veterans Administration Medical Center, Minneapolis, Minnesota.
authors.forename: C R
authors.initials: CR
authors.lastname: Clabots
authors.forename: L R
authors.initials: LR
authors.lastname: Peterson
authors.forename: D N
authors.initials: DN
authors.lastname: Gerding
mesh_terms: D001427:Bacterial Toxins / Q000096:biosynthesis; D015139:Blotting, Southern; D002981:Clindamycin / Q000494:pharmacology; D003013:Clostridium / Q000145:classification* / Q000187:drug effects / Q000235:genetics; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D003603:Cytotoxins / Q000096:biosynthesis; D004262:DNA Restriction Enzymes; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D010957:Plasmids
chemical_list: D001427:Bacterial Toxins; D003603:Cytotoxins; D004269:DNA, Bacterial; D002981:Clindamycin; D004262:DNA Restriction Enzymes