Serogrouping of Clostridium difficile strains by slide agglutination

Six different agglutinating antisera were obtained by immunizing rabbits with Formol-treated strains of Clostridium difficile. After appropriate absorption, these antisera were used to define six serogroups designated by the letters A, B, C, D, F, and G. Altogether, 315 strains of C. difficile from various origins were tested for slide agglutination by these antisera; 312 (99%) of them were agglutinated by one of these antisera. A and C were the most common serogroups. An excellent correlation, ranging from 85 to 100%, was found between the serogroup and the toxigenicity of the strains. The correlation between serogroup and sorbitol fermentation was higher, ranging from 89 to 100%. The results of this typing were compared with the clinical origin of the strains. Only strains of serogroups A, C, and D were isolated in 153 cases of antibiotic-associated diarrhea. This series included strains from three outbreaks; all the strains in two of the outbreaks belonged to serogroup C, and in the third, all the strains belonged to serogroup A. Strains of serogroups B, F, and G were only found in the stools of asymptomatic neonates or young children. In the latter samples, strains of serogroups A and D were found in the same ratio as in adults with antibiotic-associated diarrhea, but strains of serogroup C were seldom isolated. In patients treated with antineoplastic drugs and suffering from diarrhea, the distribution of the strains was the same as in cases of antibiotic-associated diarrhea.