Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea.
Antibiotic-associated diarrhoea (AAD) represents a clinical entity leading to prolonged hospital stays and diagnostic and therapeutic procedures, and results in additional costs. The aim of the present study was to assess the prevalence and characteristics of different bacteria in stools of patients with AAD. The reliability of diagnostic procedures under routine conditions was evaluated. Host factors were also analysed. From June 2002 to April 2003 89 cases of diarrhoea were reported at a hospital unit for internal medicine. Clostridium difficile and Clostridium perfringens toxin enzyme-immunoassays (EIAs), and culture for C. difficile, C. perfringens and Staphylococcus aureus were performed on stool samples from all patients. Toxin production was determined in isolated S. aureus strains. In vitro susceptibility of S. aureus for oxacillin and of C. difficile for vancomycin, metronidazole, linezolid, fusidic acid and tetracycline was tested. Host factors, such as age, comorbidities, antibiotic exposure and contact with other patients, were evaluated. Twenty-six stools were positive for C. difficile toxins by an EIA technique, while C. difficile was cultured from 39. C. difficile was isolated from 21 stools that were EIA negative. Additionally, from 28 stools S. aureus and/or C. perfringens could be isolated. Nine samples contained only S. aureus and/or C. perfringens. Thirty-one stools were negative in all tests. All C. difficile isolates were susceptible to vancomycin and metronidazole. Age >60 years, and diseases of the vascular system, the heart, the kidneys and the lungs were identified as risk factors for acquiring C. difficile in this setting (P values < 0.05). Stool culture for C. difficile was shown to be more sensitive than toxin EIA in this study. Risk factors for the acquisition of C. difficile in outbreak situations seem to differ from risk factors in the normal hospital setting. The role of toxin-producing S. aureus in cases of AAD needs further investigation.
Ackermann
Grit
G
Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Germany 2Department of Internal Medicine II, St Georg Hospital, Leipzig, Germany.
Thomalla
Susanne
S
Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Germany 2Department of Internal Medicine II, St Georg Hospital, Leipzig, Germany.
Ackermann
Frank
F
Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Germany 2Department of Internal Medicine II, St Georg Hospital, Leipzig, Germany.
Schaumann
Reiner
R
Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Germany 2Department of Internal Medicine II, St Georg Hospital, Leipzig, Germany.
Rodloff
Arne C
AC
Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Germany 2Department of Internal Medicine II, St Georg Hospital, Leipzig, Germany.
Ruf
Bernhard R
BR
Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Germany 2Department of Internal Medicine II, St Georg Hospital, Leipzig, Germany.
D000900:Anti-Bacterial Agents / Q000009:adverse effects; D001427:Bacterial Toxins / Q000302:isolation & purification*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology*; D003016:Clostridium perfringens / Q000302:isolation & purification; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D003967:Diarrhea / Q000139:chemically induced / Q000175:diagnosis / Q000382:microbiology*; D004196:Disease Outbreaks; D004768:Enterotoxins / Q000032:analysis; D005243:Feces / Q000737:chemistry / Q000382:microbiology*; D006801:Humans; D011159:Population Surveillance; D015995:Prevalence; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D004768:Enterotoxins