title: Prevalence of Clostridium difficile toxins A and B and Clostridium perfringens enterotoxin A in stool samples of patients with antibiotic-associated diarrhea.
abstract: BACKGROUND
  Antibiotic-associated diarrhea (AAD) is a major nosocomial as well as a community health problem. Clostridium difficile toxins (CDT) can be detected in only 10-25% of patients with AAD. The role of Clostridium perfringens enterotoxin A (CPEnt) as a cause of AAD remains to be elucidated. We, therefore, prospectively investigated the prevalences of both CPEnt and CDT in stool samples of patients with AAD.
  
  
  METHODS
  A total of 693 stool samples consecutively submitted to our department from patients with AAD were screened for CDT and CPEnt using commercially available enzyme-linked immunoassays (ELISA). C. difficile and C. perfringens were detected by standard culture techniques. In addition, samples being CPEnt positive and/ or harboring C. perfringens were screened for the CPEnt gene by duplex PCR.
  
  
  RESULTS
  CDT was detected in 79 (11.4%) of 693 stool samples. Of these, 49 (62.0%) harbored C. difficile. In one (0.14%) of 693 samples, CPEnt could be detected by ELISA. This respective CPEnt-positive stool sample also harbored C. perfringens. 147 (21.2%) of all stool samples were culture positive for C. perfringens. We did not detect samples positive for both CPEnt and CDT. In five (3.4%) of 147 C. perfringens isolates, the CPEnt gene could be detected by duplex PCR. PCR was positive in two (40%) of the five stool samples harboring CPEnt gene-positive C. perfringens isolates.
  
  
  CONCLUSIONS
  The present prospective study revealed a prevalence of CDT of 11.4%, whereas the prevalence of CPEnt was less than 1%. Routine screening of stool samples for CPEnt does not appear to be justified in patients with AAD.
authors.affiliation: Dept. of Medical Microbiology and Immunology of Infection, Charité - Medical School Berlin, Campus Benjamin Franklin, Hindenburgdamm 27, 12203, Berlin, Germany, Markus.Heimesaat@charite.de.
authors.forename: M M
authors.initials: MM
authors.lastname: Heimesaat
authors.forename: K
authors.initials: K
authors.lastname: Granzow
authors.forename: H
authors.initials: H
authors.lastname: Leidinger
authors.forename: O
authors.initials: O
authors.lastname: Liesenfeld
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000032:analysis*; D001427:Bacterial Toxins / Q000032:analysis*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003016:Clostridium perfringens / Q000302:isolation & purification; D003967:Diarrhea / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology; D004768:Enterotoxins / Q000032:analysis* / Q000235:genetics; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry*; D006801:Humans; D016133:Polymerase Chain Reaction; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; C035598:enterotoxin, Clostridium; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile