The Epidemiology of Clostridium difficile with Use of a Typing Scheme: Nosocomial Acquisition and Cross-Infection Among Immunocompromised Patients

Identification of outbreak-associated and other strains ofClostridium difficileby numerical analysis of SDS-PAGE protein patterns

“…It is thus of interest to note that the same EP type has been responsible for outbreaks of infection on two continents. This is clearly an area for further study but it does lend support to the suggestions of others that there rnay be strain-specific differences in virulence [6][7][8][9] and that specific types are associated with major outbreaks [7,12,16]. In the Canadian study, more electrophoretypes (17) were found to be present in the hospital than in the Manchester group (5) and EP type 1 accounted for a lower proportion of the total isolates examined in the former.…”

“…Differing electrophoretic methodologies have been employed in the typing of C. difficile by protein patterns and it appears to be the most popular general approach. These include radio-labelled [12,16], EDTA-extracted surface proteins [7,22], and whole-cell proteins [23][24][25] and, in addition, these may be coupled with immunoblotting techniques [26][27][28]. Discrimination is extremely high and in theory all strains can be typed; in practice, well over 95 % of isolates can be typed to previously defined types and any new patterns can be added as new types.…”

“…Firstly, it is apparent that treatment with certain antibiotics increases susceptibility to infection by altering or displacing the balance of the normal bowel flora [10]. Secondly, there is evidence for person-toperson transmission of C. difficile in hospitals [11,12]. Thirdly, there are documented cases of contamination of the hands of health-care workers as well as of environmental contamination [13,14].…”

“…Thirdly, there are documented cases of contamination of the hands of health-care workers as well as of environmental contamination [13,14]. Within the hospital, the mode of transmission of C. difficile has, understandably, been generally evaluated in epidemic settings [7,12,15,16].…”

“…For epidemiological studies, a variety of methods have been applied to the typing of C. difficile: bacteriophage and bacteriocin typing [11,17,18], serotyping [19][20][21], protein typing (including radio-labelled [12,16], EDTA-extracted surface [7,22], and whole-cell proteins [23][24][25]), immunoblotting techniques [26][27][28], plasmid profiling [29], restriction endonuclease fingerprinting [30,31], restriction fragment length polymorphisms [32], the polymerase chain reaction [33], and pyrolysis mass spectrometry [34]. [35], infection contributed to 17 deaths amongst the mainly geriatric patients.…”