[Survey with three epidemiological markers after 22 cases of diarrhea caused by Clostridium difficile in a geriatric...

In a geriatric hospital of Saint-Etienne (Charité), among 153 patients having presented a nosocomial diarrhea from September 1990 to August 1991 Clostridium difficile (C.d.) has been isolated in 22 cases. Two of the nine units of the hospital had the highest incidence rates: 4.6 and 3.7%. In the faeces of 16 patients, C.d. was toxinogenic. In all cases, except one, antibiotic preceded diarrhea. Amoxicillin + clavulanic acid treatment was the most frequently responsible (65%). For detecting an eventual outbreak, several epidemiologic markers were evaluated: Clindamycin MIC, protein profiles, serotyping. Clindamycin susceptibility differentiated two Cd. types, but has no epidemiologic value. Protein profiles, performed by SDS-Page, individualized 6 different profiles, but 10 strains gave no classifiable profiles. Serotyping, applied by M. Delmée, appeared as the most interesting marker. Inquiry allowed to eliminate an outbreak but revealed two episodes of cross contaminations in the 3 units, 2 of them having the highest incidence rates. Markers proved persistence of the same C.d. strain in some patients who were correctly treated by metronidazole.