1887

Abstract

Summary

Isolates from a presumptive nosocomial outbreak of infection at a large teaching hospital were typed by pyrolysis mass spectrometry (PMS) and antibiograms. One isolate, from the putative index case, was dissimilar from the outbreak strain, but 24 isolates from 16 patients were indistinguishable by both methods. The outbreak centred on two wards for the acute care of the elderly, with a few cases elsewhere. Transfer of patients appeared to be the route of transmission between wards. There was a significant fall in the incidence of cases following intervention by the Infection Control Unit. This included ward inspection, advice on antibiotic usage and advice on prevention of faecal-oral transfer, particularly by proper handwashing. Subsequent monitoring of infection showed a background of sporadic, dissimilar isolates with occasional apparent cross-infection incidents limited to a few patients. In suspected outbreaks, patterns of antibiotic susceptibility may be useful in initial screening, before referral for more sophisticated typing. There was excellent correlation between PMS results, antibiograms and epidemiological information.

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1993-11-01
2024-03-29
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References

  1. Bartlett JG, Chang TW, Gurwith M, Gorbach SL, Onderdonk AB. Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. N Engl J Med 1978; 298:531–534
    [Google Scholar]
  2. Larson HE, Price AB, Honour P, Borriello SP. Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet 1978; 1:1063–1066
    [Google Scholar]
  3. MacFarland LV, Mulligan ME, Kwok RYY, Stamm MS, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989; 320:204–210
    [Google Scholar]
  4. Bender BS, Laughon BE, Gaydos C. et al. Is Clostridium difficile endemic in chronic-care facilities?. Lancet 1986; 2:11–13
    [Google Scholar]
  5. Riley TV, Bowman RA, Carroll SM. Diarrhoea associated with Clostridium difficile in a hospital population. Med J Aust 1983; 1:166–169
    [Google Scholar]
  6. Communicable Diseases Report PHLS Communicable Disease Surveillance Centre; 1992; 2:9
    [Google Scholar]
  7. Johnson S, Clabots CR, Linn FV, Olson MM, Peterson LR, Gerding DN. Nosocomial Clostridium difficile colonisation and disease. Lancet 1990; 336:97–100
    [Google Scholar]
  8. Delmée M, Laroche Y, Avesani V, Cornelis G. Comparison of serogrouping and polyacrylamide gel electrophoresis for typing Clostridium difficile. J Clin Microbiol 1986; 24:991–994
    [Google Scholar]
  9. Tabaqchali S, Holland D, O’Farrell S, Silman R. Typing scheme for Clostridium difficile: its application in clinical and epidemiological studies. Lancet 1984; 1:935–938
    [Google Scholar]
  10. Tabaqchali S, O’Farrell S, Holland D, Silman R. Method for the typing of Clostridium difficile based on polyacrylamide gel electrophoresis of [35S] methionine-labelled proteins. J Clin Microbiol 1986; 23:197–198
    [Google Scholar]
  11. Poxton IR, Byrne MD. Immunological analysis of the EDTA- soluble antigens of Clostridium difficile and related species. J Gen Microbiol 1981; 122:41–46
    [Google Scholar]
  12. Delmee M, Homel M, Wauters G. Serogrouping of Clostridium difficile strains by slide agglutination. J Clin Microbiol 1985; 21:323–327
    [Google Scholar]
  13. Sell TL, Schaberg DR, Fekety FR. Bacteriophage and bacteriocin typing scheme for Clostridium difficile. J Clin Microbiol 1983; 17:1148–1152
    [Google Scholar]
  14. Peerbooms PGH, Kuijt P, Maclaren DM. Application of chromosomal restriction endonuclease digest analysis for use as a typing method for Clostridium difficile. J Clin Pathol 1987; 40:771–776
    [Google Scholar]
  15. Burdon DW. Clostridium difficile: The epidemiology and prevention of hospital-acquired infection. Infection 1982; 10:203–204
    [Google Scholar]
  16. Cartmill TDI, Orr K, Freeman R, Sisson PR, Lightfoot NF. Nosocomial infection with Clostridium difficile investigated by pyrolysis mass spectrometry. J Med Microbiol 1992; 37:352–356
    [Google Scholar]
  17. Borriello SP, Honour P. Simplified procedure for the routine isolation of Clostridium difficile from faeces. J Clin Pathol 1981; 34:1124–1127
    [Google Scholar]
  18. Brazier JS. The role of the laboratory in investigations of Clostridium difficile diarrhoea. Clin Infect Dis 1993 in press
    [Google Scholar]
  19. Bowman RA, Arrow SA, Riley TV. Latex particle agglutination for detecting and identifying Clostridium difficile. J Clin Pathol 1986; 39:212–214
    [Google Scholar]
  20. De Girolami PC, Hanff PA, Eichelberger K. et al. Multicenter evaluation of a new enzyme immunoassay for detection of Clostridium difficile enterotoxin A. J Clin Microbiol 1992; 30:1085–1088
    [Google Scholar]
  21. Borriello SP, Vale T, Brazier JS, Hyde S, Chippeck E. Evaluation of the Premier enzyme immunoassay kit for the detection of Clostridium difficile toxin A. Eur J Clin Microbiol Infect Dis 1992; 11:360–363
    [Google Scholar]
  22. Magee JT, Hindmarch JM, Burnett IA, Pease A. Epidemiological typing of Streptococcus pyogenes by pyrolysis mass spectrometry. J Med Microbiol 1989; 30:273–278
    [Google Scholar]
  23. Hindmarch JM, Magee JT, Hadfield MA, Duerden BI. A pyrolysis-mass spectrometry study of Corynebacterium spp. J Med Microbiol 1990; 31:137–149
    [Google Scholar]
  24. Magee JT, Brazier JS, Duerden BI, Ribeiro CD. Pyrolysis mass spectrometry (PMS) of Clostridium difficile isolates from two outbreaks of antibiotic-associated diarrhoea. J Med Microbiol 1992; 37: Suppl 1 Abstract 278
    [Google Scholar]
  25. Brazier JS, Magee JT, Riley H, Costas M. Comparison of SDS- PAGE and pyrolysis mass spectrometry typing results for Clostridium difficile. In: Medical and dental aspects of anaerobes Duerden BI, Brazier JS, Wade W. (eds) Cardiff: Society for Anaerobic Microbiology; (in press)
    [Google Scholar]
  26. O’Neill GL, Beaman MH, Riley TV. Relapse versus reinfection with Clostridium difficile. Epidemiol Infect 1991; 107:627–635
    [Google Scholar]
  27. Fekety R, Kim KH, Brown D, Batts DH, Cadmore M, Silva J. Epidemiology of antibiotic-associated colitis: isolation of Clostridium difficile from the hospital environment. Am J Med 1981; 70:906–908
    [Google Scholar]
  28. Kim KH, Fekety R, Batts DH. et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis 1981; 143:42–50
    [Google Scholar]
  29. Malamou-Ladas H, O’Farrell S, Nash JQ, Tabaqchali S. Isolation of Clostridium difficile from patients and the environment of hospital wards. J Clin Pathol 1983; 36:88–92
    [Google Scholar]
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