Screening for carriage and nosocomial acquisition of Clostridium difficile by culture: a study of 284 admissions of elderly patients to six general hospitals in Wales

Brazier, Jon S.; Fitzgerald, T. C.; Hosein, I. K.; Cefai, C.; Looker, Nick; Walker, Moira; Bushell, A.C.; Rooney, Paul J.

doi:10.1016/s0195-6701(99)90431-0

Cited by 26 publications

(24 citation statements)

References 5 publications

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“…Carriage of C. difficile in contacts to patients with CDAD is not uncommon (7,10,15,19). Among 59 such contacts in the present study, 12% were positive for C. difficile by culture and/or fecal detection of cytotoxin B.…”

Section: Discussionmentioning

confidence: 45%

Epidemiology and Molecular Characterization of Clostridium difficile Strains from Patients with Diarrhea: Low Disease Incidence and Evidence of Limited Cross-Infection in a Swedish Teaching Hospital

et al. 2003

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We prospectively studied the epidemiology of Clostridium difficile-associated diarrhea (CDAD) in a 900-bed hospital over the course of 12 months by PCR-ribotyping of C. difficile isolates. A total of 304 cases were diagnosed, corresponding to an overall incidence of 7/1,000 admissions, with higher rates in nephrology, hematology, and organ transplantation wards (37, 30, and 21/1,000), and 72% were classified as hospital associated (onset in hospital or onset at home but after a hospital stay within 2 months). All 382 isolates from 227 of 304 (75%) patients available for PCR-ribotyping were typeable, yielding 70 PCR-ribotypes. The three most common types comprised 30% of hospital-associated and 34% of community-associated cases, indicating import via admitted patients as a major source of C. difficile strains occurring in the hospital. Of the 227 patients studied, 38% each contributed 2 to 13 fecal samples positive for C. difficile over the course of the study period. Repeat isolates of the same PCR-ribotype as the first isolate were found in 79% of these patients and in 95% of specimens delivered within 30 days, compared to 63% of those obtained at 31 to 204 days. Nosocomial acquisition of CDAD, defined as the proportion of cases sharing C. difficile type and admitted to the same ward within 2 or 12 months, was 20% and 32% of hospital-associated cases and 14% and 23% of all cases, respectively. Thus, most CDAD cases diagnosed over the course of the study period, including those associated with hospitalization, appeared to be caused by endogenous C. difficile strains rather than by strains truly being acquired in the hospital.

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Section: Discussionmentioning

confidence: 45%

Epidemiology and Molecular Characterization of Clostridium difficile Strains from Patients with Diarrhea: Low Disease Incidence and Evidence of Limited Cross-Infection in a Swedish Teaching Hospital

et al. 2003

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“…[3][4][5] This can be increased to 20-50% for those patients who are hospitalised. [6][7][8] In about a third of those colonised, 7 C. difficile produces protein exotoxins that have a cytotoxic action on the bowel mucosa, creating a wide spectrum of symptoms from uncomplicated diarrhoea to pseudomembranous colitis with toxic megacolon.…”

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confidence: 99%

Clostridium Difficile in Urology

Hossain

Crook

Keoghane

2008

annals

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INTRODUCTIONThe objective was to determine the incidence of Clostridium difficile infection in a UK urology ward from 2000 to 2005, and correlate and compare the data with other specialty wards and national figures.PATIENTS AND METHODS Urology patients with a positive stool culture for C. difficile between 2000 and 2005 were identified from a hospital database. The medical records of these patients were reviewed and data such as antibiotic use, urological diagnosis and elective/emergency status of the patient were recorded and analysed. The number of C. difficile cases on an elderly care ward, an acute medical ward and an acute surgical ward were also recorded for this period. Data on the number of admissions and occupied bed-days on all 4 wards were compared.

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“…In an investigation of six different Welsh hospitals, 16·5 % elderly patients acquired C. difficile during their hospital stay. Two of the Welsh hospitals investigated reported that C. difficile was not isolated and the range of acquisition by patients in the other four hospitals was 4-24 % (Brazier et al, 1999). In a chronic care facility for the elderly, approximately 30 % of patients were found to harbour C. difficile.…”

Section: Discussionmentioning

confidence: 98%

“…In healthy adults, the rate of asymptomatic colonization is thought to be less than 5 % (Ambrose et al, 1985;Aronsson et al, 1985;Phillips & Rogers, 1981). However, several studies have shown that rates in hospitalized elderly patients may be much higher (Bender et al, 1986;Brazier et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile in a geriatric unit: a prospective epidemiological study employing a novel S-layer typing method

McCoubrey

Starr

Martin

et al. 2003

Journal of Medical Microbiology

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Clostridium difficile is the major identifiable cause of antibiotic-associated diarrhoea in the UK. The aim of this study was to employ traditional culture, toxin detection and a novel typing method to determine the level of C. difficile colonization and disease in a population of elderly patients and to investigate the association between strains in the patients and their environment. Three hundred and ninety patients between 62 and 101 years of age admitted to a geriatric unit in the Royal Victoria Hospital (RVH), Edinburgh, were investigated for the presence of C. difficile. C. difficile was cultured from 100 (26 %) patients using pre-reduced cycloserine-cefoxitin egg yolk agar, and toxin(s) was detected in the faeces of 34 of these patients using the Techlab ELISA test kit for the detection of C. difficile toxins A and/or B. Toxin(s) was detected in a further 18 patients from whom no C. difficile was detected in culture. Of the patients in whom C. difficile was detected, 49 % had diarrhoea, with the highest proportion of patients with diarrhoea being both culture-and toxin-positive for C. difficile. Environmental sampling of the patient environment yielded C. difficile from 14 % of samples. The organism was most frequently isolated from floors, sluice-rooms and toilet areas. The variation in the molecular mass of the C. difficile S-layer proteins was exploited as the basis of a novel typing method for C. difficile. Isolates from patients in the RVH were given a four-digit 'S-type' number based on their S-layer protein profile. A total of seven S-types were identified, with one type, toxigenic S-type 5236, accounting for 73 % of all clinical isolates and 91 % of environmental isolates.

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Screening for carriage and nosocomial acquisition of Clostridium difficile by culture: a study of 284 admissions of elderly patients to six general hospitals in Wales

Cited by 26 publications

References 5 publications

Epidemiology and Molecular Characterization of Clostridium difficile Strains from Patients with Diarrhea: Low Disease Incidence and Evidence of Limited Cross-Infection in a Swedish Teaching Hospital

Epidemiology and Molecular Characterization of Clostridium difficile Strains from Patients with Diarrhea: Low Disease Incidence and Evidence of Limited Cross-Infection in a Swedish Teaching Hospital

Clostridium Difficile in Urology

Clostridium difficile in a geriatric unit: a prospective epidemiological study employing a novel S-layer typing method

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