1887

Abstract

Antibiotic-associated diarrhoea (AAD) represents a clinical entity leading to prolonged hospital stays and diagnostic and therapeutic procedures, and results in additional costs. The aim of the present study was to assess the prevalence and characteristics of different bacteria in stools of patients with AAD. The reliability of diagnostic procedures under routine conditions was evaluated. Host factors were also analysed. From June 2002 to April 2003 89 cases of diarrhoea were reported at a hospital unit for internal medicine. and toxin enzyme-immunoassays (EIAs), and culture for , and were performed on stool samples from all patients. Toxin production was determined in isolated strains. susceptibility of for oxacillin and of for vancomycin, metronidazole, linezolid, fusidic acid and tetracycline was tested. Host factors, such as age, comorbidities, antibiotic exposure and contact with other patients, were evaluated. Twenty-six stools were positive for toxins by an EIA technique, while was cultured from 39. was isolated from 21 stools that were EIA negative. Additionally, from 28 stools and/or could be isolated. Nine samples contained only and/or . Thirty-one stools were negative in all tests. All isolates were susceptible to vancomycin and metronidazole. Age >60 years, and diseases of the vascular system, the heart, the kidneys and the lungs were identified as risk factors for acquiring in this setting ( values < 0.05). Stool culture for was shown to be more sensitive than toxin EIA in this study. Risk factors for the acquisition of in outbreak situations seem to differ from risk factors in the normal hospital setting. The role of toxin-producing in cases of AAD needs further investigation.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.45812-0
2005-02-01
2019-11-22
Loading full text...

Full text loading...

/deliver/fulltext/jmm/54/2/JM540208.html?itemId=/content/journal/jmm/10.1099/jmm.0.45812-0&mimeType=html&fmt=ahah

References

  1. Abrahao, C., Carman, R. J., Hahn, H. & Liesenfeld, O. ( 2001;). Similar frequency of detection of Clostridium perfringens enterotoxin and Clostridium difficile toxins in patients with antibiotic-associated diarrhoea. Eur J Clin Microbiol Infect Dis 20, 676–677.
    [Google Scholar]
  2. Ackermann, G., Adler, D. & Rodloff, A. C. ( 2003;). In vitro activity of linezolid against Clostridium difficile. J Antimicrob Chemother 51, 743–745.[CrossRef]
    [Google Scholar]
  3. Adesiyun, A. A., Lenz, W. & Schaal, K. P. ( 1992;). Phage susceptibility, enterotoxigenicity and antibiograms of Staphylococcus aureus strains isolated from human wounds and diarrhoea. Zentralbl Bakteriol 277, 250–259.[CrossRef]
    [Google Scholar]
  4. Al-Eidan, F. A., McElnay, J. C., Scott, M. G. & Kearney, M. P. ( 2000;). Clostridium difficile-associated diarrhoea in hospitalised patients. J Clin Pharm Ther 25, 101–109.[CrossRef]
    [Google Scholar]
  5. Barbut, F., Delmée, M., Brazier, J. S. & 10 other authors ( 2003;). A European survey of diagnostic methods and testing protocols for Clostridium difficile. Clin Microbiol Infect 9, 989–996.[CrossRef]
    [Google Scholar]
  6. Boone, J. H. & Carman, R. J. ( 1997;). Clostridium perfringens: food poisoning and antibiotic-associated diarrhea. Clin Microbiol Newsl 19, 65–67.[CrossRef]
    [Google Scholar]
  7. Borriello, S. P., Welch, A. R., Larson, H. E. & Barclay, F. ( 1984;). Enterotoxigenic Clostridium perfringens: a possible cause of antibiotic-associated diarrhoea. Lancet 1, 305–307.
    [Google Scholar]
  8. Brazier, J. S., Fawley, W., Freeman, J. & Wilcox, M. H. ( 2001;). Reduced susceptibility of Clostridium difficile to metronidazole. J Antimicrob Chemother 48, 741–742.[CrossRef]
    [Google Scholar]
  9. Cohen, S. H., Tang, Y. J. & Silva, J. Jr ( 2000;). Analysis of the pathogenicity locus in Clostridium difficile strains. J Infect Dis 181, 659–663.[CrossRef]
    [Google Scholar]
  10. Cunningham, R., Dale, B., Undy, B. & Gaunt, N. ( 2003;). Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea. J Hosp Infect 54, 243–245.[CrossRef]
    [Google Scholar]
  11. Deutsches Institut für Normung e.V. ( 2000;). Medizinische Mikrobiologie und Immunologie: Diagnostische Verfahren. Berlin/Wien/Zürich: Beuth.
  12. Fekety, R., McFarland, L. V., Surawicz, C. M., Greenberg, R. N., Elmer, G. W. & Mulligan, M. E. ( 1997;). Recurrent Clostridium difficile diarrhea: characteristics of and risk factors for patients enrolled in a prospective, randomized, double-blinded trial. Clin Infect Dis 24, 324–333.[CrossRef]
    [Google Scholar]
  13. Freeman, J. & Wilcox, M. H. ( 2003;). The effect of storage conditions on viability of Clostridium difficile vegetative cells and spores and toxin activity in human faeces. J Clin Pathol 56, 126–128.[CrossRef]
    [Google Scholar]
  14. Frost, F., Craun, G. F. & Calderon, R. L. ( 1998;). Increasing hospitalization and death due to Clostridium difficile diarrheal disease. Emerg Infect Dis 4, 619–625.[CrossRef]
    [Google Scholar]
  15. George, W. L., Sutter, V. L., Citron, D. & Finegold, S. M. ( 1979;). Selective and differential medium for the isolation of Clostridium difficile. J Clin Microbiol 9, 214–219.
    [Google Scholar]
  16. Gravet, A., Rondeau, M., Harf-Monteil, C., Grunenberger, F., Monteil, H., Scheftel, J.-M. & Prévost, G. ( 1999;). Predominant Staphylococcus aureus isolated from antibiotic-associated diarrhea is clinically relevant and produces enterotoxin A and the bicomponent toxin LukE-LukD. J Clin Microbiol 37, 4012–4019.
    [Google Scholar]
  17. Jang, S. S., Hansen, L. M., Breher, J. E., Riley, D. A., Magdesian, K. G., Madigan, J. E., Tang, Y. J., Silva, J., Jr & Hirsh, D. C. ( 1997;). Antimicrobial susceptibilities of equine isolates of Clostridium difficile and molecular characterization of metronidazole-resistant strains. Clin Infect Dis 25, S266–S267.[CrossRef]
    [Google Scholar]
  18. Komatsu, M., Kato, H., Aihara, M. & 8 other authors ( 2003;). High frequency of antibiotic-associated diarrhea due to toxin A-negative, toxin B-positive Clostridium difficile in a hospital in Japan and risk factors for infection. Eur J Clin Microbiol Infect Dis 22, 525–529.[CrossRef]
    [Google Scholar]
  19. Kyne, L., Hamel, M. B., Polavaram, R. & Kelly, C. P. ( 2002;). Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 34, 346–353.[CrossRef]
    [Google Scholar]
  20. McDonald, M., Ward, P. & Harvey, K. ( 1982;). Antibiotic-associated diarrhoea and methicillin-resistant Staphylococcus aureus. Med J Aust 1, 462–464.
    [Google Scholar]
  21. McFarland, L. V., Surawicz, C. M., Rubin, M., Fekety, R., Elmer, G. W. & Greenberg, R. N. ( 1999;). Recurrent Clostridium difficile disease: Epidemiology and clinical characteristics. Infect Control Hosp Epidemiol 20, 43–50.[CrossRef]
    [Google Scholar]
  22. Modi, N. & Wilcox, M. H. ( 2001;). Evidence for antibiotic induced Clostridium perfringens diarrhoea. J Clin Pathol 54, 748–751.[CrossRef]
    [Google Scholar]
  23. National Committee for Clinical Laboratory Standards ( 2004;). Methods for antimicrobial susceptibility testing of anaerobic bacteria; approved standard, 6th edn. Villanova, PA, USA: National Committee for Clinical Laboratory Standards. NCCLS publication no. M11-A6 NCCLS.
  24. Oeding, P. & Austarheim, K. ( 1954;). The occurrence of staphylococci in the intestinal content after treatment with antibiotics. Acta Pathol Microbiol Scand 35, 473–483.
    [Google Scholar]
  25. Peláez, T., Alcala, L., Alonso, R., Rodriguez-Creixems, M., Garcia-Lechuz, J. M. & Bouza, E. ( 2002;). Reassessment of Clostridium difficile susceptibility to metronidazole and vancomycin. Antimicrob Agents Chemother 46, 1647–1650.[CrossRef]
    [Google Scholar]
  26. Schwaber, M. J., Simhon, A., Block, C., Roval, V., Ferderber, N. & Shapiro, M. ( 2000;). Factors associated with nosocomial diarrhea and Clostridium difficile-associated disease on the adult wards of an urban tertiary care hospital. Eur J Clin Microbiol Infect Dis 19, 9–15.[CrossRef]
    [Google Scholar]
  27. Starr, J. M., Martin, H., McCoubrey, J., Gibson, G. & Poxton, I. R. ( 2003;). Risk factors for Clostridium difficile colonisation and toxin production. Age Ageing 32, 657–660.[CrossRef]
    [Google Scholar]
  28. Stubbs, S. L. J., Brazier, J. S., O'Neill, G. L. & Duerden, B. I. ( 1999;). PCR targeted to the 16S-23S rRNA gene intergenic spacer region of Clostridium difficile and construction of a library consisting of 116 different PCR ribotypes. J Clin Microbiol 37, 461–463.
    [Google Scholar]
  29. Wong, S. S., Woo, P. C., Luk, W. K. & Yuen, K. Y. ( 1999;). Susceptibility testing of Clostridium difficile against metronidazole and vancomycin by disk diffusion and Etest. Diagn Microbiol Infect Dis 34, 1–6.[CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.45812-0
Loading
/content/journal/jmm/10.1099/jmm.0.45812-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error