High Frequency of Antibiotic-Associated Diarrhea due to Toxin A-Negative, Toxin B-Positive Clostridium difficile in a Hospital in Japan and Risk Factors for Infection

Abstract

Patients hospitalized in a hospital with a high incidence of antibiotic-associated diarrhea due to toxin A-negative, toxin B-positive (A-/B+) Clostridium difficile were retrospectively investigated to determine the clinical manifestations and risk factors for infection. Of 77 Clostridium difficile isolates obtained from 77 patients during the 1-year investigation period, 30 were A-/B+ and 47 were toxin A-positive, toxin B-positive (A+/B+). By pulsed-field gel electrophoresis analysis, 23 of the 30 A-/B+ strains were outbreak-related, suggesting nosocomial spread of a single type of bacterium, which mainly affected patients in the wards of respiratory medicine, hematology and neurology. Using regression analysis, three factors were found to be associated with infection by A-/B+ isolates: (i) exposure to antineoplastic agents ( P=0.01, odds ratio [OR]=5.1), (ii) the use of nasal feeding tubes ( P=0.008, OR=5.2), and (iii) assignment to a certain internal medicine ward ( P=0.05, OR=3.0). Between patients with Clostridium difficile-associated diarrhea caused by A-/B+ strains and those with A+/B+ strains, no statistically significant difference was found in body temperature, serum concentration of C-reactive protein, leukocyte count in whole blood, frequency of diarrhea, or type of underlying disease. These results indicate that A-/B+ strains of Clostridium difficile can cause intestinal infection in humans and they spread nosocomially in the same manner as A+/B+ strains.

A comparison of Clostridium difficile diagnostic methods for identification of local strains in a South African centre

“…The predominance of ribotype 017 strains in the set of isolates is similar to reports from healthcare centres in China (Hawkey et al, 2013;Huang et al, 2009), Taiwan (Chia et al, 2013), Korea (Shin et al, 2008) and Japan (Komatsu et al, 2003). There have also been smaller outbreaks of ribotype 017 strains in Canada (al-Barrak et al, 1999) and Europe (Drudy et al, 2007;Kuijper et al, 2001).…”

“…Nevertheless, in line with other investigations reported, the current study yielded a 22.0 % incidence of C. difficile, compared with a 9.2 % incidence with the sole use of ImmunoCard for Toxin A and B (Cohen et al, 2010; Rajabally et al, 2013;Sloan et al, 2008;Terhes et al, 2009). The predominance of ribotype 017 strains in the set of isolates is similar to reports from healthcare centres in China (Hawkey et al, 2013;Huang et al, 2009), Taiwan (Chia et al, 2013, Korea (Shin et al, 2008) and Japan (Komatsu et al, 2003). There have also been smaller outbreaks of ribotype 017 strains in Canada (al-Barrak et al, 1999) and Europe (Drudy et al, 2007;Kuijper et al, 2001).…”

Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

“…Older age, female gender and a prolonged hospital stay were identified risk factors in hospitalized CDAD patients (Al-Eidan et al, 2000). More recent studies reported the association of the use of proton pump inhibitors within the preceding 8 weeks, the use of nasal feeding tubes and exposure to antineoplastic agents with an increased risk of C. difficile diarrhoea (Cunningham et al, 2003;Komatsu et al, 2003). Some of the risk factors identified in this study differ from those reported in other investigations.…”

Rapid and Simple Method for Detecting the Toxin B Gene of Clostridium difficile in Stool Specimens by Loop-Mediated Isothermal Amplification

“…However, these tests were found not to be as sensitive as the cell culture assay (6,19,22), and the infection caused by TcdA-negative, TcdB-positive (A Ϫ B ϩ ) C. difficile could not be diagnosed by using only the TcdA detection kit (1,3,16,17,18). Culture of C. difficile is a sensitive and specific method when cultured isolates are tested for TcdA and TcdB production (7).…”