title: Clostridium difficile prevalence rates in a large healthcare system stratified according to patient population, age, gender, and specimen consistency.
abstract: We evaluated Clostridium difficile prevalence rates in 2,807 clinically indicated stool specimens stratified by inpatient (IP), nursing home patient (NH), outpatient (OP), age, gender, and specimen consistency using bacterial culture, toxin detection, and polymerase chain reaction (PCR) ribotyping. Rates were determined based on the detection of toxigenic C. difficile isolates. We identified significant differences in the rates between patient populations and with age. Specimens from NH had a higher rate (46%) for toxigenic C. difficile than specimens from IP (18%) and OP (17%). There were no gender-related differences in the rates. Liquid specimens had a lower rate (15%) than partially formed and soft specimens (25%) and formed specimens (18%) for the isolation of toxigenic C. difficile. The nontoxigenic rate was lowest for NH (4%) and highest for patients<20 years of age (23%). We identified 31 different toxigenic ribotypes from a sampling of 190 isolates that showed the lowest diversity in NH. Fluoroquinolone resistance was observed in 93% of the 027 isolates, all of the 053 isolates, and in four other ribotypes. We observed different rates for toxigenic C. difficile in stratified patient populations, with the highest rate for NH, a low overall nontoxigenic rate, and fluoroquinolone resistance.
authors.affiliation: Research and Development, TechLab, Inc., 2001 Kraft Drive, Blacksburg, VA 24060, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Boone
authors.forename: M
authors.initials: M
authors.lastname: Goodykoontz
authors.forename: S J
authors.initials: SJ
authors.lastname: Rhodes
authors.forename: K
authors.initials: K
authors.lastname: Price
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.forename: K N
authors.initials: KN
authors.lastname: Gearhart
authors.forename: R J
authors.initials: RJ
authors.lastname: Carman
authors.forename: T M
authors.initials: TM
authors.lastname: Kerkering
authors.forename: T D
authors.initials: TD
authors.lastname: Wilkins
authors.forename: D M
authors.initials: DM
authors.lastname: Lyerly
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D016360:Clostridioides difficile / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005243:Feces / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology; D006268:Health Facilities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D021521:Ribotyping; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
chemical_list: D024841:Fluoroquinolones