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Prospective study of Clostridium difficile colonization and paracresol detection in the stools of babies on a special
Insights
Clostridium difficile colonization was common in infants on a special care unit, but no cytotoxin was detected. Nosocomial spread is suspected, influenced by factors like prolonged stays and low birth weight.
Area of Science:
- Microbiology
- Neonatalogy
- Infectious Diseases
Background:
- Clostridium difficile is an opportunistic pathogen.
- Infant colonization rates and risk factors require further investigation.
Purpose of the Study:
- To investigate Clostridium difficile colonization and cytotoxin presence in infants.
- To identify risk factors for colonization and evaluate detection methods.
Main Methods:
- Stool samples from infants on a special care baby unit were analyzed over one year.
- Environmental screening and antibiogram analysis were performed.
- Gas-liquid chromatography was used to detect para-cresol.
Main Results:
- 21% of infants were colonized with Clostridium difficile; no cytotoxin was detected.
- Colonization was linked to prolonged unit stay, low birth weight, and incubator use.
- Para-cresol detection was specific but not sensitive for Clostridium difficile.
Conclusions:
- Clostridium difficile was acquired through nosocomial spread, though the exact mechanism remains unclear.
- Risk factors for colonization include prematurity and extended hospitalization.
- Para-cresol is not a reliable screening tool for infant Clostridium difficile infection.
Abstract:
Infants' stools were examined for the presence of Clostridium difficile and its cytotoxin in a study performed over a one-year period on a special care baby unit. Overall, 21% of infants were colonized, but the organism was only recovered in a seven-month period during which its weekly prevalence in the group varied from zero to 44%, with a distinct clustering of colonized infants being observed. Tests for the presence of cytotoxin in the stools and in supernatants of broth that had been inoculated with each isolate were negative. The factors predisposing to colonization were a prolonged stay in the unit, low birth weight, younger gestational age and being nursed in an incubator. The organism was recovered only once from an environmental screen. An antibiogram, used in conjunction with toxin production, was helpful in distinguishing these isolates from a collection obtained from other units in the hospital. We conclude that Cl. difficile was acquired by nosocomial spread although we did not establish the precise mechanism involved. The detection of para-cresol by gas-liquid chromatography was found to be specific but insufficiently sensitive as a screening test for the organism's presence in the stools. It could only be demonstrated in infants whose birth-weights were less than 2500 g, and no association was observed between the type of feed and para-cresol presence in stools.