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Clostridium difficile in a geriatric unit: a prospective epidemiological study employing a novel S-layer typing
Jodie McCoubrey1, John Starr1, Heather Martin1
1Medical Microbiology, Centre for Infectious Diseases, The University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK 2Geriatric Medicine Unit, University of Edinburgh, Royal Victoria Hospital, Craigleith Road, Edinburgh EH4 2DN, UK.
Journal of Medical Microbiology
|June 17, 2003
Summary
Clostridium difficile (C. difficile) causes significant antibiotic-associated diarrhea in elderly patients. A novel S-type typing method identified a dominant toxigenic strain prevalent in patients and their hospital environment.
Area of Science:
- Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Clostridium difficile is a primary cause of antibiotic-associated diarrhea (AAD) in the UK.
- Elderly patients are particularly susceptible to C. difficile infections.
Purpose of the Study:
- To determine C. difficile colonization and disease levels in elderly patients.
- To investigate the association between patient and environmental C. difficile strains.
- To introduce and utilize a novel S-layer protein typing method.
Main Methods:
- Culture and toxin detection (ELISA) for C. difficile in 390 elderly patients.
- Environmental sampling within the hospital geriatric unit.
- Novel S-type typing based on C. difficile S-layer protein profiles.
Main Results:
- C. difficile cultured from 26% of patients; toxins detected in 52 patients (culture-positive or negative).
- 49% of C. difficile-positive patients had diarrhea, most being culture- and toxin-positive.
- 14% of environmental samples were positive; floors and sluice rooms were common sources.
- Seven S-types identified; toxigenic S-type 5236 comprised 73% of clinical and 91% of environmental isolates.
Conclusions:
- A single toxigenic C. difficile S-type (5236) dominates clinical and environmental isolates in this geriatric unit.
- The novel S-typing method effectively tracks C. difficile transmission.
- Environmental contamination plays a significant role in C. difficile spread within healthcare settings.