Application of a technique for serogrouping Clostridium difficile in an outbreak of antibiotic-associated diarrhoea

A severe outbreak of Clostridium difficile antibiotic-associated diarrhoea (AAD) in an orthopaedic surgical unit is reported. Thirty-seven cases and eight relapses were observed. The 45 related strains together with another 13 strains of C. difficile isolated during the same period in other wards of the same hospital were typed by detection of cytotoxin production, determination of sorbitol fermentation and serogrouping by agglutination with six rabbit antisera defining the serogroups A, B, C, D, F and G. All the strains from the outbreak belonged to serogroup C, were toxigenic and fermented sorbitol. In contrast, four different patterns were observed in seven isolates from cases of AAD in other wards. Finally, six strains isolated from four asymptomatic adults, one adult suffering from shigellosis and one child with salmonellosis demonstrated two patterns different from that of the epidemic isolates. The data strongly suggest nosocomial spread of this micro-organism.