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Investigation of an outbreak of antibiotic-associated colitis by various typing methods
Abstract:
During an outbreak of diarrheal disease due to Clostridium difficile in a surgical ward, 16 C. difficile isolates were cultured from fecal samples of 15 patients. Agarose gel electrophoresis for the detection of plasmid DNA, crossed immunoelectrophoresis for the detection of extracellular antigens and toxins, polyacrylamide gel electrophoresis for analyses of soluble proteins, assays for cytotoxicity, and a comparison of susceptibility to antimicrobial agents were employed. At least 12 of the 16 isolates were shown to be phenotypically the same strain. These findings suggest that in a hospital setting, diarrhea and pseudomembranous colitis caused by C. difficile can be of nosocomial origin and that they can spread from patient to patient.
Insights
This study investigated a Clostridium difficile outbreak in a surgical ward. Findings indicate that the diarrheal disease was likely hospital-acquired and spread between patients.
Area of Science:
- Infectious Diseases
- Microbiology
- Hospital Epidemiology
Background:
- Clostridium difficile is a significant cause of nosocomial infections, particularly in healthcare settings.
- Outbreaks of C. difficile-associated diarrhea (CDAD) can lead to severe patient outcomes, including pseudomembranous colitis.
- Understanding the transmission dynamics of C. difficile is crucial for infection control.
Purpose of the Study:
- To investigate the cause and transmission of a diarrheal disease outbreak in a surgical ward.
- To determine if the Clostridium difficile isolates involved in the outbreak were of nosocomial origin.
- To characterize the phenotypic properties of the C. difficile strains implicated in the outbreak.
Main Methods:
- Phenotypic characterization of 16 Clostridium difficile isolates from 15 patients using agarose gel electrophoresis for plasmid DNA, crossed immunoelectrophoresis for antigens and toxins, and polyacrylamide gel electrophoresis for soluble proteins.
- Assessment of isolate cytotoxicity.
- Comparison of antimicrobial susceptibility profiles.
Main Results:
- At least 12 of the 16 C. difficile isolates exhibited identical phenotypic characteristics, suggesting a single predominant strain.
- The outbreak involved a specific strain of C. difficile.
- The findings support the hypothesis of patient-to-patient transmission.
Conclusions:
- The outbreak of diarrheal disease caused by Clostridium difficile in the surgical ward was likely of nosocomial origin.
- Patient-to-patient transmission is a probable mechanism for the spread of C. difficile within the hospital setting.
- Effective infection control measures are essential to prevent and manage C. difficile outbreaks in hospitals.