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PubMed2002

Characterization of Clostridium difficile isolates from foals with diarrhea: 28 cases (1993-1997).

OBJECTIVE: To determine molecular characteristics of Clostridium difficile isolates from foals with diarrhea and identify clinical abnormalities in affected foals. DESIGN: Retrospective study. ANIMALS: 28 foals with C difficile-associated diarrhea. PROCEDURE: Toxigenicity, molecular fingerprinting, and antibiotic susceptibility patterns were determined. Information on signalment, clinical findings, results of clinicopathologic testing, whether antimicrobials had been administered prior to development of diarrhea, and outcome was obtained from the medical records. RESULTS: Twenty-three (82%) foals survived. Toxin A and B gene sequences were detected in isolates from 24 of 27 foals, whereas the toxin B gene alone was detected in the isolate from 1 foal. Results of an ELISA for toxin A were positive for fecal samples from only 8 of 20 (40%) foals. Ten of 23 (43%) isolates were resistant to metronidazole. Molecular fingerprinting revealed marked heterogeneity among isolates, except for the metronidazole-resistant isolates. Sixteen foals had tachypnea. Hematologic abnormalities were indicative of inflammation. Common serum biochemical abnormalities included metabolic acidosis, hyponatremia, hypocalcemia, azotemia, hypoproteinemia, hyperglycemia, and high enzyme activities. Passive transfer of maternal antibodies was adequate in all 12 foals evaluated. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that a large percentage of C difficile isolates from foals with diarrhea will have the toxin A and B gene sequences. Because of the possibility that isolates will be resistant to metronidazole, susceptibility testing is warranted. Clostridium difficile isolates from foals may have a substantial amount of molecular heterogeneity. Clinical and hematologic findings in affected foals are similar to those for foals with diarrhea caused by other pathogens.

Animals↗
PubMed1998

Recognizing and managing Clostridium difficile-associated diarrhea.

Clostridium difficile-associated diarrhea poses a significant physical risk and cost to the recovery of hospitalized older adults. C. difficile is responsible for 75% or more of the diarrhea-associated enteric infections acquired during a hospital stay (Gerding, Johnson, Peterson, Mulligan, & Silva, 1995). C. difficile is easily spread by direct or indirect contact, therefore placing other patients at great risk for contamination by this organism. Nursing plays a significant role in early identification, management, and control of the spread of this potentially lethal infection.

Adult↗
PubMed1999

[Nosocomial infections].

GLYCOPEPTIDE RESISTANCE: Resistance to glycopeptides raises many therapeutic problems when it occurs in strains such as enterococci or staphylococci causing clinical infections. Two observations described here exemplify the emergence of such resistance in a metacillin-resistant Staphylococcus aureus (MRSA) strain during vancomycin treatment and in a Clostridium difficile strain. NASAL MRSA IN HOSPITAL PERSONNEL: Nasal cavities of hospital personnel is a not well recognized reservoir of MRSA. A survey conducted in a Parisian hospital evidenced problems of personnel-patient transmission. MRSA were found in 6% of the hospital personnel samples.

Anti-Bacterial Agents↗
PubMed2006

Production of xylitol by metabolically engineered strains of Bacillus subtilis.

Xylitol-phosphate dehydrogenase (XPDH) genes from several Gram-positive bacteria were isolated and expressed in Bacillus subtilis. The substrate specificities of the recombinant XPDH enzymes were compared and it was found that the XPDH enzymes of Lactobacillus rhamnosus and Clostridium difficile had the highest selectivity towards D-xylulose 5-phosphate. Expression of these two XPDH enzymes in D-ribulose and D-xylulose producing B. subtilis strain resulted in strains of B. subtilis capable of converting D-glucose into xylitol at around 23% yield.

Bacillus subtilis↗
PubMed1995

Differentiation of Clostridium difficile, Clostridium bifermentans, Clostridium sordellii, and Clostridium perfringens from diarrheal stool by API ZYM and API LRA oxidase test.

A simple, rapid and reliable outline for identification of clostridia isolates from human infections was developed. It consists of a combination of API ZYM and API LRA Oxidase tests. The enzymatic activities were performed with strains sub-cultured onto carbohydrate-free medium (Columbia blood agar). Fifty-five strains of Clostridium difficile, C. bifermentans, C. sordellii, and C. perfringens from clinical specimens and eight reference standard strains representing different species of the same genus were analyzed. The accuracy of the new method was evaluated by comparison with the results obtained by DNA/DNA analysis.

Bacterial Typing Techniques↗
PubMed2003

Fluoroquinolone use and Clostridium difficile-associated diarrhea.

We performed a case-control study to evaluate the association between antibiotic use and Clostridium difficile-associated diarrhea (CDAD), matching for admission unit and time at risk for CDAD. A multivariable regression model showed that treatment with fluoroquinolones (odds ratio 12.7; 95% confidence interval 2.6 to 61.6) was the strongest risk factor for CDAD.

Aged↗
PubMedDate not supplied

Evaluation of a commercial latex agglutination assay for screening for Clostridium difficile-associated disease.

OBJECTIVE: To determine if the Clostridium difficile latex agglutination assay is an effective screening procedure for the diagnosis of C. difficile-associated disease (CDAD). DESIGN: Convenience sample. SETTING: The Washington Hospital, a 364-bed, secondary, acute-care center in Washington, Pennsylvania. PARTICIPANTS: A total of 321 women and 195 men aged 21 days to 100 years. INTERVENTIONS: Diarrheal stool specimens from patients on antibiotic therapy were randomly tested for the presence of C. difficile-associated antigen by CULTURETTE brand latex agglutination assay (Beckton Dickinson Microbiology Systems, Cockeyesville, MD 21030). Latex-positive samples were confirmed or negated by cytotoxin assay using the Toxi-titer microtiter plate system (Baxter Healthcare Corp., Bartels Diagnostic Division, Issaquah, WA 98027). MAIN OUTCOME MEASURES: Comparative statistical analysis of the raw data to develop the sensitivity and specificity of the latex screening assay. RESULTS: Stool specimens of 403 patients (78.1%) were negative for C. difficile-associated antigen. Of the latex-positive specimens, 70 (69.3%) were also cytotoxin-positive. Of the indeterminate latex specimens, four (33.3%) were cytotoxin-positive. A total of 70 specimens (13.6%) were positive by both methods and 74 patients (14.3%) were diagnosed with CDAD. Based on this data, the latex agglutination screening assay had a sensitivity of 77.1% and a specificity of 93.4%. CONCLUSION: Latex agglutination for C. difficile-associated antigen is a moderately sensitive screening test for a presumptive diagnosis of CDAD. However, it is not the best screening test for CDAD compared with the new enzyme-linked immunosorbent assay (ELISA) techniques for toxins A and B.

Adolescent↗
PubMed1999

[Clostridium difficile diarrhea in the very old. Clinical features and course in 21 cases].

OBJECTIVES: Determine the clinical and etiological features of Clostridium difficile diarrhea in elderly subjects. PATIENTS AND METHODS: We retrospectively analyzed 21 cases of C. difficile diarrhea observed in patients at the Dijon geriatric center from January 1994 through December 1995. The diagnosis was established on C. difficile toxin evidenced in fecal matter. RESULTS: There were 13 women and 8 men (mean age 85.9 years). All patients had several underlying disease conditions and were highly dependent. Three outbreaks involving 11 patients were observed. In more than half of the patients, the primary clinical signs were colitis with fever, highly elevated erythrocyte sedimentation rate and high white cell count. Eleven patients also had candidiasis of the digestive tract. All patients had received one or several antibiotics during the 15 days prior to diarrhea. The main antibiotic families were aminopenicillins, cephalosporins and fluoroquinolones. Twenty patients were given specific treatment: imidazoles in 15 cases and vancomycin in 9. Diarrhea was successfully controlled in 14 cases. There were 2 cases of recurrence and 6 patients died after a cascade of complications. C. difficile infection persisted in 2 at death. DISCUSSION: Over recent years C. difficile diarrhea has become a serious problem in geriatric units. Antibiotic therapy is the main risk factor as well as protein-calorie malnutrition, immunodeficiency, and colonic stasis. Morbidity and mortality are high in fragile elderly subjects.

Aged↗
PubMed1992

[Preliminary epidemiological study of carriers of Clostridium difficile].

171 samples have been taken from stools of sick persons in three departments of university and hospital centres of Algiers (C.H.U.A.): the department of maternity (C.H.U Parnet), the department of breast diseases (CPMC), the department of women's surgery (CPMC), 13 samples of C. difficile have been isolated with a frequency of 7.6 per 100 of cases. The rate of conveyance seems more important in adults in hospitals and often concerns sick persons enduring digestive cancer (10.25 per 100) or newborn with a frequency of 8.73 per 100.

Adult↗
PubMed1992

Colonisation with digoxin-reducing strains of Eubacterium lentum and Clostridium difficile infection in nursing home patients.

Stool specimens obtained from 77 residents of a nursing home were analysed to determine the relationship between colonisation with digoxin-reducing strains of Eubacterium lentum and infection with Clostridium difficile. Patients were categorised according to previous antibiotic treatment, prescription of enteral feedings, and pattern of bowel habits. Colonisation with digoxin-reducing E. lentum was less common in subjects infected with C. difficile, in those treated with antibiotics previously, and in those prescribed enteral feedings. Normal bowel habits were more common in those without C. difficile. The lowest incidence of diarrhoea was seen in patients without C. difficile who were colonised with digoxin-reducing species. This study establishes an inverse relationship between the presence of C. difficile and E. lentum that reduce digoxin which is related to previous treatment with antibiotics and prescription of enteral feedings. Bacterial markers may prove to be a useful tool for predicting clinical disturbances in bowel function.

Adult↗
PubMed1991

Comparative studies of serotype-specific Clostridium difficile strains.

The following properties of serotype-specific Clostridium difficile strains were studied: toxigenicity, encapsulation, susceptibility to certain antibiotics, biochemical properties, enzymatic activity. No correlation between toxin titer and frequency of capsule production as well as serogroup affiliation and sensitivity to antibiotics was observed. The strain representative of serogroup C attracts attention because of its distinct properties.

Clostridioides difficile↗
PubMed1993

Impact of cefpodoxime proxetil and amoxicillin on the normal oral and intestinal microflora.

Ten healthy volunteers were given 200 mg cefpodoxime proxetil tablets every 12 h and ten volunteers received 500 mg amoxicillin tablets every 8 h for seven days and the impact of the agents on the oral and intestinal microflora was studied. In the oral microflora, only minor alterations were observed in both groups. In subjects receiving cefpodoxime proxetil, the numbers of streptococci, enterobacteria and clostridia were strongly reduced in the faecal flora, while there was an overgrowth of enterococci, yeasts and Clostridium difficile. Amoxicillin administration induced somewhat smaller alterations in the faecal microflora, although all subjects had overgrowth of new colonizing amoxicillin resistant microorganisms, mainly Escherichia coli, Klebsiella and Enterobacter. Beta-lactamase activity was detected in the flora of six volunteers from each group.

Adult↗
PubMed2003

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.

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.

Adolescent↗
PubMed2005

Quantification of Bifidobacterium spp., Escherichia coli and Clostridium difficile in faecal samples of breast-fed and formula-fed infants by real-time PCR.

To determine the influence of either exclusive breast-feeding or formula feeding on both composition and quantity of the gut microbiota in infants, we have developed real-time, quantitative PCR assays for the detection of Bifidobacterium spp. and Clostridium difficile. Furthermore, we have monitored the prevalence and counts of Escherichia coli by applying a previously described real-time PCR assay. We found all 100 infants tested to be colonized by Bifidobacterium spp. The bifidobacterial counts were comparable between the 50 breast-fed and 50 formula-fed infants with median values of 10.56 log10 and 10.24 log10 CFU g(-1) wet weight faeces, respectively. C. difficile was detected in 14% of the breast-fed and 30% of the formula-fed infants. In addition, the C. difficile counts were significantly lower in breast-fed infants than in the formula-fed group (median values of 3.28 log10 and 7.43 log10 CFU g(-1), respectively; p=0.03). The prevalence of E. coli in the breast-fed and formula-fed group was 80% and 94%, respectively. Also, the E. coli counts in colonized infants was significantly lower in the breast-fed infants than in the formula-fed group (median values of 9.11 log10 and 9.57 log10 CFU g(-1), respectively; p=0.004). We conclude that the prevalence and counts of C. difficile as well as E. coli are significantly lower in the gut microbiota of breast-fed infants than in that of formula-fed infants, whereas the prevalence and counts of Bifidobacterium spp. is similar among both groups.

Bifidobacterium↗
PubMed2005

Parasites in nosocomial diarrhoea: are they underestimated?

Nosocomial diarrhoea, defined as diarrhoea occurring more than 72 h after hospital admission, is reported to account for <1% of endemic nosocomial infections and 17% of epidemic nosocomial infections. The yield of diagnoses from stool cultures in nosocomial diarrhoea is low, and information regarding the role of parasites is limited. We conducted a study to determine the responsible bacterial and parasitological pathogens from nosocomial diarrhoea cases in our 2000-bed tertiary care facility over a 16-month period. Of 226 patients, Clostridium difficile toxins A or B were present in 5.5%, giardia cysts and/or trophozoites in 4.4%, Blastocytis hominis in 4.4% and Cryptosporidium sp. in 0.5% of samples. In conclusion, parasites should be sought in nosocomial diarrhoea in endemic areas.

Animals↗
PubMed2015

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

BACKGROUND: The epidemiology of Clostridium difficile-associated infection (CDI) has changed, and it is evident that susceptibility is related not only to exposures and bacterial potency, but host factors as well. Several small studies have suggested that CDI after trauma is associated with a different patient phenotype. The purpose of this study was to examine and describe the epidemiologic factors associated with C. difficile in blunt trauma patients without traumatic brain injury using the Trauma-Related Database as a part of the "Inflammation and Host Response to Injury" (Glue Grant) and the University of Florida Integrated Data Repository. METHODS: Previously recorded baseline characteristics, clinical data, and outcomes were compared between groups (67 C. difficile and 384 uncomplicated, 813 intermediate, and 761 complicated non-C. difficile patients) as defined by the Glue Grant on admission and at days seven and 14. RESULTS: The majority of CDI patients experienced complicated or intermediate clinical courses. The mean ages of all cohorts were less than 65&#x2009;y and CDI patients were significantly older than uncomplicated patients without CDI. The CDI patients had increased days in the hospital and on the ventilator, as well as significantly higher new injury severity scores (NISS), and a greater percentage of patients with NISS >34 points compared with non-CDI patients. They also had greater Marshall and Denver multiple organ dysfunction scores than non-CDI uncomplicated patients, and greater creatinine, alkaline phosphatase, neutrophil count, lactic acid, and PiO2:FiO2 compared with all non-CDI cohorts on admission. In addition, the CDI patients had higher glucose concentrations and base deficit from uncomplicated patients and greater leukocytosis than complicated patients on admission. Several of these changes persisted to days seven and 14. CONCLUSION: Analysis of severe blunt trauma patients with C. difficile, as compared with non-CDI patients, reveals evidence of increased inflammation, immunosuppression, worse acute kidney injury, higher NISS, greater days in the hospital and on the ventilator, higher organ injury scores, and prolonged clinical courses. This supports reports of an increased prevalence of CDI in a younger population not believed previously to be at risk. This unique population may have specific genomic or inflammation-related risk factors that may play more important roles in disease susceptibility. Prospective analysis may allow early identification of at-risk patients, creation of novel therapeutics, and improved understanding of how and why C. difficile colonization transforms into infection after severe blunt trauma.

Adolescent↗
PubMed1992

Evaluation of new anti-infective drugs for the treatment of antibiotic-associated colitis. Infectious Diseases Society of America and the Food and Drug Administration.

Colitis due to Clostridium difficile is diagnosed in 10%-15% of hospitalized patients who develop diarrhea after treatment with antimicrobial drugs. Diagnosis is based on the concurrence of diarrhea, one or more signs or symptoms of enteric intoxication, and stool from which toxigenic C. difficile is isolated or from which its toxins are identified. Clinical trials evaluating therapy may be placebo controlled (for mild disease) or concurrently controlled with an active drug. A randomized, double-blind study design is preferred. Outcome should be assessed by monitoring of the degree of inflammation of the bowel mucosa, the intensity and severity of diarrhea, the duration of illness, changes in stool form, and the eradication of C. difficile or its toxins from stool. Because C. difficile can be a component of the normal gastrointestinal flora, assessment of clinical outcome is paramount.

Anti-Bacterial Agents↗
PubMed1998

Comparison of restriction enzyme analysis, arbitrarily primed PCR, and protein profile analysis typing for epidemiologic investigation of an ongoing Clostridium difficile outbreak.

During an outbreak of diarrhea in a general hospital in 1992, 166 Clostridium difficile isolates from 102 patients were typed by restriction enzyme analysis (REA), arbitrarily primed PCR (AP-PCR), and protein profile analysis (PP) techniques. A total of 18 types and 5 subtypes were identified by REA, 32 types were identified by AP-PCR, and 9 types were identified by PP. Analysis of the data indicated the presence of a predominant strain among 76, 75, and 84% of the isolates by REA, AP-PCR, and PP, respectively. Subsequently, 45 C. difficile isolates which had been collected in 1990 from 33 patients in the same hospital following a significant increase in the number of cases of diarrhea caused by C. difficile were studied by REA, AP-PCR, and PP typing techniques. Thirteen types and one subtype were identified by REA, 12 types were identified by AP-PCR, and 5 types were identified by PP. As with the isolates from 1992, a dominant strain was identified. This strain was represented by 53, 64, and 70% of the total number of isolates when the strains were typed by REA, AP-PCR, and PP, respectively. Every isolate (210 of 211) from both 1990 and 1992 that was available for typing was typeable by all three methods. Furthermore, the same dominant strain was identified in both 1990 and 1992 by each method. This study demonstrates that each of the three typing methods can be useful in epidemiologic investigations of C. difficile outbreaks and that one strain can be dominant in an institution over a number of years.

Adult↗