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Culturing and Maintaining Clostridium difficile in an Anaerobic Environment
Published on: September 14, 2013
Clostridium difficile in a children's hospital: assessment of environmental contamination
Simone Warrack1, Megan Duster1, Sarah Van Hoof2
1Department of Medicine, University of Wisconsin Medical School, Madison, WI.
Insights
Three pediatric Clostridium difficile infection (CDI) cases prompted an investigation. Environmental Clostridium difficile contamination was prevalent, but molecular typing ruled out person-to-person transmission, highlighting environmental reservoirs.
Area of Science:
- Infectious Diseases
- Microbiology
- Hospital Epidemiology
Background:
- Clostridium difficile infection (CDI) is a leading cause of health care-associated diarrhea.
- Three pediatric CDI cases occurred within 48 hours in a hospital's hematology/oncology ward.
Observation:
- Environmental sampling in shared areas of the pediatric unit revealed C. difficile in 28% of samples.
- Molecular typing (pulsed-field gel electrophoresis) was used to compare bacterial strains.
Findings:
- No patient isolates matched each other or environmental isolates.
- C. difficile was widespread in the shared environments of the pediatric unit.
- Person-to-person transmission was not supported by the molecular data.
Implications:
- Environmental contamination with C. difficile is a significant concern in pediatric hospital settings.
- Molecular typing is a valuable tool for elucidating transmission pathways of C. difficile.
- Findings suggest environmental reservoirs, not direct transmission, as a likely factor in the observed cases.
Abstract:
Clostridium difficile infection (CDI) is the most frequent infectious cause of health care-associated diarrhea. Three cases of CDI, in children age 2, 3, and 14 years, occurred in the hematology/oncology ward of our children's hospital over 48 hours. We aimed to assess environmental contamination with C difficile in the shared areas of this unit, and to determine whether person-to-person transmission occurred. C difficile was recovered from 5 of 18 samples (28%). We compared C difficile isolated from each patient and the environment using pulsed-field gel electrophoresis, and found that none of the patient strains matched any of the others, and that none matched any strains recovered from the environment, suggesting that person-to-person transmission had not occurred. We found that C difficile was prevalent in the environment throughout shared areas of the children's hospital unit. Molecular typing to identify mechanisms of transmission is useful for devising appropriate interventions.
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