Nosocomial Clostridium difficile reservoir in a neonatal intensive care unit

A new bacteriophage/bacteriocin typing system was used to study Clostridium difficile colonization in a neonatal intensive care unit. C. difficile was isolated from 21 of 62 (34%) stools from 15 of 37 (41%) infants. Colonization was reduced during antimicrobial therapy and for about 1 week thereafter. One of five nurses and one of two parents studied were carriers. Eight isolates were cultured from environmental surfaces. Thirty of 31 C. difficile isolates were found to be a single type, Cld 6,9,10,13; bacteriocin 1320,1537,2304. No C. difficile was found in 29 specimens obtained in the delivery room from mothers and infants, and there was no association of early colonization with vaginal delivery. The data provide strong evidence for nosocomial acquisition of C. difficile by infants in the neonatal intensive care unit. No obvious pathologic role for C. difficile could be identified among colonized infants. Among 22 C. difficile isolates from 7 adult inpatients with diarrhea and 13 healthy infants attending the center's well baby clinic, 4 were the same type as the strain found in the intensive care nursery. Only one of these patients had had direct contact with the neonatal intensive care unit, indicating that the nursery strain may also be found elsewhere in the community.