Nosocomial Outbreak of Clostridium difficile-Associated Diarrhoea due to a Clindamycin-Resistant Enterotoxin A-Negative Strain

Kuijper, Ed J.; Weerdt, J. De; Kato, Haru; Kato, Naoya; Dam, Alje P. van; Vorm, E. R. Van Der; Weel, JF; Rheenen, C. Van; Dankert, J.

doi:10.1007/s100960100550

Cited by 121 publications

(113 citation statements)

References 29 publications

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“…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). Ribotype 017 strains typically have a truncated version of the tcdA gene and, therefore, only produce functional TcdB, yet are still capable of causing severe disease and are often resistant to multiple antibiotics (Drudy et al, 2007;Spigaglia et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

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

Rajabally

Kullin

Ebrahim

et al. 2016

Journal of Medical Microbiology

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Accurate diagnosis of Clostridium difficile infection is essential for disease management.A clinical and molecular analysis of C. difficile isolated from symptomatic patients at Groote Schuur Hospital, South Africa, was conducted to establish the most suitable clinical test for the diagnosis and characterization of locally prevalent strains. C. difficile was detected in stool samples using enzyme-based immunoassays (EIA) and nucleic acid amplification methods, and their performance was compared with that of C. difficile isolation using direct selective culture combined with specific PCR to detect the C. difficile tpi gene, toxin A and B genes and binary toxin genes. Toxigenic isolates were characterized further by ribotyping. Selective culture isolated 32 C. difficile strains from 145 patients (22 %). Of these, the most prevalent (50 %) were of ribotype 017 (toxin A 2 B + ) while 15.6 % were ribotype 001 (toxin A + B + ). No ribotype 027 strains or binary toxin genes (cdtA and cdtB) were detected. The test sensitivities and specificities, respectively, of four commercial clinical diagnostic methods were as follows: ImmunoCard Toxins A & B (40 % and 99.1 %), VIDAS C. difficile Toxin A & B (50 % and 99.1 %), GenoType CDiff (86.7 % and 88.3 %) and Xpert C. difficile (90 % and 97.3 %). Ribotype 001 and 017 strains had a 100 % detection rate by Xpert C. difficile, 100 % and 93.3 % by GenoType CDiff, 75 % and 53.3 % by ImmunoCard and 75 % and 60 % by VIDAS, respectively. The overall poor performance of EIA suggests that a change to PCR-based testing would assist diagnosis and ensure reliable detection of locally prevalent C. difficile 017 strains. INTRODUCTIONOver the last decade, Clostridium difficile infection (CDI) has emerged as an important healthcare problem, both in the hospital setting and in the community. There has been growing concern over its rising incidence, disease severity and mortality. Major epidemics, causing significant loss of lives, have been reported in North America and Europe (Birgand et al., 2010; Healthcare Commission, 2006; Pépin et al., 2004). These epidemics have been attributed to virulent strains capable of producing more than ten times the amount of toxins than conventional strains (Kelly & LaMont, 2008;McDonald et al., 2005;O'Connor et al., 2009). In addition, the 'hyper virulent' 027 strain has developed resistance to antibiotics such as fluoroquinolones (Pépin et al., 2005).In South Africa, information on CDI remains scarce. Yet, there are some studies that have shown that CDI in this Abbreviations: CA, community acquired; CDI, Clostridium difficile infection; EIA, enzyme-based immunoassays; GDH, glutamate dehydrogenase; HA, hospital acquired; NLR, negative likelihood ratio; NPV, negative predictive value; PLR, positive likelihood ratio; PPV, positive predictive value. part of the world is not insignificant. In 2008, an institution in Pretoria reported a sudden increase in toxin-producing C. difficile, raising the alert of a possible outbreak and sensitizing its clinicians (Lekala...

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Section: Discussionmentioning

confidence: 99%

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

Rajabally

Kullin

Ebrahim

et al. 2016

Journal of Medical Microbiology

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“…However, the fact that we picked several colonies on the plate in order to perform the IA decreases the probability of missing a toxigenic strain. On the other hand, toxin Bpositive/toxin A-negative isolates could also have been missed, a type of strain which has been reported to account for up to 3 % of the strains in some studies (Barbut et al, 2002;Kuijper et al, 2001;Samra et al, 2002). Such strains, however, would have been detected by the cytotoxin assay, which has a sensitivity of about 60 % as discussed below.…”

Section: Discussionmentioning

confidence: 99%

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture

Delmée

Broeck

Simon

et al. 2005

Journal of Medical Microbiology

147

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A routine protocol for diagnosing Clostridium difficile-associated diarrhoea (CDAD) based on both faecal-cytotoxin detection and toxigenic culture was adopted by the microbiology laboratory of the St Luc-UCL University Hospital in Brussels in 1997. A toxigenic culture is a faecal culture followed, in the case of positivity, by a direct immunoassay on colonies to detect toxin A production. The results obtained over the past 7 years in the hospital are reviewed here. A total of 10 552 diarrhoeal stools from 7042 patients were analysed, of which 9494 were negative for all tests. A total of 1058 samples (10 %) from 794 patients were culture-positive, of which 460 (4 . 4 %) were positive for a faecal cytotoxin. The remaining 598 cultures were tested for toxin A on colonies; 355 of them were positive, which is 3 . 4 % of the total, and the remaining 243 (2 . 3 %) were negative. The positivity of the faecalcytotoxin assay was statistically linked to the number of colonies observed on the culture plate. In conclusion, over a 7 year period, toxigenic culture allowed the diagnosis of 355 cases of CDAD that would have been missed by a protocol using a faecal-cytotoxin assay alone. In terms of both patient care, prevention of environmental contamination and prevention of risk of a hospital outbreak, it is proposed that these results justify the recommendation to perform both faecal-toxin assay and culture in routine medical practice.

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“…According to Bauer et al [3], hospitalized patients with diarrhea who have been or who are being treated with antibiotics and cytostatics should always have their feces tested for Clostridium difficile. Kuijper et al [13] reported that diarrhea caused by Clostridium difficile occurs more frequently in elderly patients who have been submitted to surgery and in patients placed in the ICU. In another study, carried out in England, 75% of the cases of intestinal infection caused by Clostridium difficile occurred in patients over 64 years of age [5].…”

Section: Discussionmentioning

confidence: 99%

Nosocomial diarrhea in the intensive care unit

Marcon¹,

Gamba²,

Vianna³

2006

Braz J Infect Dis

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We made an epidemiological case-control study to examine risk factors for the development of diarrhea in the intensive care unit (ICU) of a public hospital in Santo André, SP, from January to October 2002. Forty-nine patients with diarrhea (cases) and 49 patients without diarrhea (controls), matched for age and gender, were included in the study. A stool culture and enzyme immunoassays for Clostridium difficile toxins A and B were performed on fecal specimens from diarrhea patients.

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Nosocomial Outbreak of Clostridium difficile-Associated Diarrhoea due to a Clindamycin-Resistant Enterotoxin A-Negative Strain

Cited by 121 publications

References 29 publications

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

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

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture

Nosocomial diarrhea in the intensive care unit

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