title: Nosocomial outbreak of Clostridium difficile-associated diarrhoea due to a clindamycin-resistant enterotoxin A-negative strain.
abstract: A clindamycin-resistant toxin A-negative, toxin B-positive Clostridium difficile strain caused an outbreak among 24 hospitalized patients at the Department of Surgery, the Intensive Care unit, and the Department of Internal Medicine of an 800-bed academic hospital. Nineteen patients had undergone a surgical intervention and all 24 patients received at least one dose of antibiotics prior to the development of Clostridium difficile-associated diarrhoea. Twenty-seven episodes of Clostridium difficile-associated diarrhoea in 24 patients were categorized as mild (n=19), severe (n=7), or fatal (n=1). Relapses occurred in three patients. Nineteen of the 27 episodes required anti-Clostridium difficile treatment. Molecular typing performed by arbitrary primer polymerase chain reaction (PCR) and PCR amplification of rRNA intergenic spacer regions revealed that the outbreak strains recovered from culture were identical. The outbreak strain belonged to serogroup F and was resistant to erythromycin, clindamycin, and tetracycline, whereas susceptibility to chloramphenicol varied. No phenotypic activity of enterotoxin A was detected. A deletion of approximately 1.7 kb was found in the toxin A gene. Cytotoxin B had an unusual effect on cell culture assays that, at first, was not recognized as Clostridium difficile specific but could be neutralized with anti-Clostridium difficile B cytotoxin.
authors.affiliation: Department of Medical Microbiology and Hospital Hygiene, Academic Medical Center of the University of Amsterdam, The Netherlands. e.j.kuijper@lumc.nl
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: J
authors.initials: J
authors.lastname: de Weerdt
authors.forename: H
authors.initials: H
authors.lastname: Kato
authors.forename: N
authors.initials: N
authors.lastname: Kato
authors.forename: A P
authors.initials: AP
authors.lastname: van Dam
authors.forename: E R
authors.initials: ER
authors.lastname: van der Vorm
authors.forename: J
authors.initials: J
authors.lastname: Weel
authors.forename: C
authors.initials: C
authors.lastname: van Rheenen
authors.forename: J
authors.initials: J
authors.lastname: Dankert
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins; D001427:Bacterial Toxins / Q000235:genetics / Q000633:toxicity; D002981:Clindamycin / Q000494:pharmacology; D016360:Clostridioides difficile / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology; D004768:Enterotoxins / Q000235:genetics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D015995:Prevalence
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile; D002981:Clindamycin