title: Characterization of Clostridium perfringens strains isolated from Polish patients with suspected antibiotic-associated diarrhea.
abstract: BACKGROUND
  The aim of our research was to investigate the role of enterotoxin- producing anaerobic bacteria other than Clostridium difficile in the etiology of antibiotic-associated diarrhea. This article presents data related to C. perfringens.
  
  
  METHODS
  Stool samples taken from 158 patients with suspected antibiotic-associated diarrhea were specifically cultured for Clostridium difficile, Bacteroides fragilis and Clostridium perfringens. In order to associate the presence of virulence factors in the bacterial isolates thus collected with disease features, all strains were genetically and phenotypically analyzed for toxin production. All isolated C. perfringens strains were cultured in Ellner sporulation-promoting medium.
  
  
  RESULTS
  In 21 of the 158 patients (13%) C. perfringens could be cultivated from the fecal specimen. None of the strains produced enterotoxin, and consequently the cpe gene was not detected by PCR in any of these strains. C. perfringens and C. difficile were cultivated from the same stool samples in 4 cases. Interestingly, in one case toxin A-negative/toxin B positive C. difficile and non-enterotoxigenic C. perfringens were co-cultured. After application of a heat shock (100 degrees C at 30 min.) only two C. perfringens strains producing thermoresistant spores were detected. Pulsed field gel electrophoresis (PFGE) demonstrated genetic heterogenicity among the C. perfringens strains, suggesting that these bacteria were already presented upon hospital admission.
  
  
  CONCLUSIONS
  It seems unlikely that nosocomial transfer has taken place. The relatively low incidence suggests that C. perfringens is not a major primary cause of antibiotic-associated diarrhea.
authors.affiliation: Department of Medical Microbiology, Center of Biostructure Research, The Medical University, Warsaw, Poland.
authors.forename: Hanna
authors.initials: H
authors.lastname: Pituch
authors.forename: Nicole
authors.initials: N
authors.lastname: van den Braak
authors.forename: Alex
authors.initials: A
authors.lastname: van Belkum
authors.forename: Willem
authors.initials: W
authors.lastname: Van Leeuwen
authors.forename: Piotr
authors.initials: P
authors.lastname: Obuch-Woszczatyński
authors.forename: Mirosław
authors.initials: M
authors.lastname: Łuczak
authors.forename: Henri
authors.initials: H
authors.lastname: Verbrugh
authors.forename: Felicja
authors.initials: F
authors.lastname: Meisel-Mikołajczyk
authors.forename: Gayane
authors.initials: G
authors.lastname: Martirosian
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000494:pharmacology*; D001441:Bacteroides fragilis; D003016:Clostridium perfringens / Q000145:classification* / Q000378:metabolism*; D003967:Diarrhea / Q000209:etiology / Q000382:microbiology*; D004768:Enterotoxins / Q000494:pharmacology; D005243:Feces / Q000382:microbiology; D006801:Humans; D010802:Phylogeny; D011044:Poland
chemical_list: D000900:Anti-Bacterial Agents; D004768:Enterotoxins