[Clostridium difficile and antibiotic-associated colitis in risk patients: 2-month epidemiologic study in an...

A toxin produced by Clostridium difficile has been implicated in the pathogenesis of antibiotic-associated colitis. It is not known how often the microorganism is encountered in Germany particularly in high risk patients. Therefore, following a lethal case of colitis, stool samples of 90 patients and 30 staff members of an intensive care unit were screened routinely for C. difficile over 2 months. The organism was found in 6 of 41 patients treated with antibiotics (14.6%); four of them apparently acquired C. difficile while in hospital whereas in 2 a pre-existing carrier state could not be excluded. Colitis developed in 3 of the 6 patients as judged from endoscopy or a positive cytotoxin assay; in 2 patients (not subjected to endoscopy) colitis was suspected on clinical grounds, and 1 patient became an asymptomatic carrier. C. difficile was not found in 49 patients without antibiotic medication, in the health personal and in 12 patients of a general ward. Patients harbouring C. difficile were clustered in certain bed sites of the unit. Environmental studies recovered the microorganism from bed pan washing machines of bedridden and from toilets of ambulant patients but not from other sites like the hands of the personal. These results suggest that chronic carriers of C. difficile, as far as they are identified by current bacteriological methods, are rare in Germany (not more than 2 out of 132 persons investigated, i.e. 1.5%). The frequent finding of C. difficile in patients treated in certain bed sites supports the view that the infection may be acquired from exogenous sources. Antibiotic-associated colitis should be considered more often when intensive care patients are treated with antibiotics.