Isolation of Clostridium difficile from the Environment and Contacts of Patients with Antibiotic-Associated Colitis

Kim, K.-H.; Fekety, Robert; Batts, Donald H.; Brown, Douglas L.; Cudmore, Margaret A.; Silva, J.; Waters, David C.

doi:10.1093/infdis/143.1.42

Cited by 466 publications

(247 citation statements)

References 27 publications

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“…Person-to-person transmission on hospital wards, especially geriatric wards, as well as environmental contamination and carriage on the hands of hospital workers have been documented (Kim et al, 1981;MalamouLadas et al, 1983;Savage & Alford, 1983;McFarland et al, 1989). Transmission occurs mainly via the faecal oral route and direct contact with contaminated surfaces (Barbut & Petit, 2001).…”

Section: Introductionmentioning

confidence: 99%

Prevalent PCR ribotypes of clinical and environmental strains of Clostridium difficile isolated from intensive-therapy unit patients in Kuwait

Rotimi

Jamal

Mokaddas

et al. 2003

Journal of Medical Microbiology

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Ninety-five isolates of Clostridium difficile from symptomatic and asymptomatic patients and 18 from their environment in the intensive-therapy units (ITUs) of four teaching hospitals in Kuwait were typed by PCR amplification of rRNA intergenic spacer regions (PCR ribotyping). A total of 32 different ribotypes was detected among the clinical isolates. The predominant ribotypes from the clinical isolates were types 097 and 078, which accounted for $ 40 % of all isolates in the ITUs in Kuwait. Ribotypes 097 (toxigenic), 078 (toxigenic) and 039 (non-toxigenic) were three distinct clones that were circulating in all four hospitals. Ribotypes 097, 078 and 076 (i.e. 50 % of isolates from symptomatic patients) were the predominant isolates associated with C. difficile-associated disease (CDAD). The environmental isolates belonged to a diverse range of ribotypes, with no particular types common to all the hospitals. Ribotype 078 was found only in the patient environment in Mubarak hospital, while ribotype 097 was restricted to Amiri hospital. The hospital environment occupied by symptomatic as well as symptom-free patients was contaminated with C. difficile. Eight new strains that did not match any in the PCR ribotype library established at the PHLS Anaerobe Reference Unit, Cardiff, UK, were assigned ribotypes 105, 125, 128, 129, 131, 134, 140 and 141. These findings show that the isolates associated with CDAD in Kuwait are different from those found in the UK and some other European countries. INTRODUCTIONClostridium difficile is an anaerobic, Gram-positive, sporeforming bacillus. It is often associated with a spectrum of diseases, referred as C. difficile-associated disease (CDAD), which manifest as self-limiting antibiotic-associated diarrhoea (AAD), antibiotic-associated colitis (AAC) and pseudomembranous colitis (PMC) with toxic megacolon and possible gut perforation. Rarely, it can present as extraintestinal infections, such as arthritis, osteomyelitis, softtissue infection and bacteraemia (Levett, 1986). CDAD is an important clinical problem because it is often acquired by hospitalized patients, and C. difficile is associated with outbreaks of diarrhoea and colitis in hospitalized adults receiving antibiotics (Bartlett et al., 1978;Djuretic et al., 1999).In spite of major efforts to control the spread of CDAD in hospitals and nursing homes, this organism has remained a major problem worldwide, and it continues to be responsible for endemic and epidemic nosocomial diarrhoea (McFarland et al., 1989; Johnson et al., 1990;Barbut et al., 1996). C. difficile, or its toxins, has been identified in 8-10 % of cases of nosocomial diarrhoea, while other common bacterial enteric pathogens, Salmonella, Shigella and Campylobacter spp., are rarely isolated (Fan et al., 1993;Rohner et al., 1997).It appears that the most important sources of C. difficile in a hospital setting are symptomatic patients and asymptomatic carriers who are the main reservoirs of C. difficile in the hospital. The environment of these patients is also an...

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Section: Introductionmentioning

confidence: 99%

Prevalent PCR ribotypes of clinical and environmental strains of Clostridium difficile isolated from intensive-therapy unit patients in Kuwait

Rotimi

Jamal

Mokaddas

et al. 2003

Journal of Medical Microbiology

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“…Environmental contamination has been suggested as a significant factor in the transmission of C. dificile (Fekety et al, 1980;Larson et al, 1980). Survival of C. dificile in an aerobic environment is possible because this obligate anaerobe can form aerotolerant spores; there are reports that C. dzficile can survive for > 5 months in aerobic conditions (Kim et al, 1981). Although it is well known that C. dificile spores cannot be effectively recovered in ordinary growth medium (Raibaud et al, 1980), their recovery is distinctly enhanced when they are treated with sodium thioglycollate and inoculated in lysozyme containing media (Ionesco, 1978 ;Nakamura et al, 1985).…”

Section: Introductionmentioning

confidence: 99%

Recovery of spores of Clostridium difficile altered by heat or alkali

Kamiya

Yamakawa²,

Ogura³

et al. 1989

Journal of Medical Microbiology

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Summary. The effect of heating or alkali-treatment on spore recovery in ordinary growth medium was examined for four strains of Clostridium dificile. Heating spores at 80°C for 10 min produced 95-50-99-95% decreases in the recovery rates. Treatment with 0.1 N NaOH for 15 rnin produced 99-47 and 99.83% decreases in spore recovery rates for two of the four strains. The influence of either addition of lysozyme after treatment with sodium thioglycollate (thioglycollate-lysozyme method) or addition of sodium taurocholate (taurocholate method) on recovery of heat-or alkali-treated C. dificile spores was also examined. Viable spores of all strains altered by heating at 90°C or 100°C for 10 min could not be recovered at all by the taurocholate method. Nor did this method allow recovery of alkali-altered spores treated with >0-2 N NaOH for 15 min. On the other hand, 10-47% of altered spores heated at 90°C for 10 min were recovered by the thioglycollate-lysozyme method, and alkali-altered spores treated with 0.1-0.3 N NaOH for 15 min were as completely recovered by this method as untreated spores. These results indicate that the thioglycollate-lysozyme method is more effective than the taurocholate method for recovery of the heat-or alkali-altered C. dificile spores.

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“…N osocomial acquisition and transmission of Clostridium difficile are well known (1)(2)(3)(4). Despite efforts to control and prevent infections in health care facilities, nosocomially acquired C difficile-associated diarrhea (N-CDAD) persists; some have reported that the number of N-CDAD infections are increasing (5)(6)(7)(8)(9)(10).…”

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confidence: 99%

N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

Hyland

Ofner-Agostini²,

Miller

et al. 2001

Canadian Journal of Infectious Diseases and Medical Microbiolog

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BACKGROUND:A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC) sites revealed variations in the prevention, detection, management and surveillance ofClostridium difficile-associated diarrhea (CDAD). Facilities wanted to establish national rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada) and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada.OBJECTIVE:To establish national prevalence rates of N-CDAD.METHODS:For six weeks in 1997, selected CHEC sites tested all diarrheal stools from inpatients for eitherC difficiletoxin orC difficilebacteria with evidence of toxin production. Questionnaires were completed for patients with positive stool assays who met the case definitions.RESULTS:Nineteen health care facilities in eight provinces participated in the project. The overall prevalence of N-CDAD was 13.0% (95% CI 9.5% to 16.5%). The mean number of N-CDAD cases were 66.3 cases/100,000 patient days (95% CI

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Isolation of Clostridium difficile from the Environment and Contacts of Patients with Antibiotic-Associated Colitis

Cited by 466 publications

References 27 publications

Prevalent PCR ribotypes of clinical and environmental strains of Clostridium difficile isolated from intensive-therapy unit patients in Kuwait

Prevalent PCR ribotypes of clinical and environmental strains of Clostridium difficile isolated from intensive-therapy unit patients in Kuwait

Recovery of spores of Clostridium difficile altered by heat or alkali

N‐CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N‐CDAD Prevalence Surveillance Project

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