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Nosocomial diarrhoeas in a surgical division hyperendemic for Clostridiuni difficile: Epidemiologic aspects emerging from an analysis of clinical records

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Abstract

Having previously shown that Clostridium difficile was responsible for an intense and protracted endemic of nosocomial diarrhoeas in the surgical division of a Tuscan hospital, we started a retrospective analysis on all records from the affected division, to cover a period of 15 months.

A statistical description is given of a large series of nosocomial diarrhoeas, as well as direct estimates of their incidence rates in selected high risk subgroups.

The situation described is epidemiologically unique, and its study tells how an endemic may reach a steady state of high nosocomial morbidity.

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References

  1. Abeyesundere R.L. (1982): A ward outbreak of Clostridium difficile enterocolitis. -J. Infect., 5: 277–282.

    Article  Google Scholar 

  2. Aronsson B., Granström M., Mollby R. and Nord C.E. (1983): Enzyme linked immunosorbent assay (ELISA.) for antibodies to Clostridium difficile toxin in patients with pseudomembranous colitis and antibiotic-associated diarrhoea. -J. Immunol. Meth., 60: 341–350.

    Article  CAS  Google Scholar 

  3. Aronsson B., Mollby R. and Nord C.E. (1982): Clostridium difficile and antibiotic-associated diarrhea in Sweden. -Scand. J. Infect. Dis., S 35: 53–58.

    Google Scholar 

  4. Bartlett J.G. (1979): Antimicrobial agent-associated pseudomembranous colitis in patients. - Microbiology, D. Schlessinger Ed., 264–266.

  5. Bartlett J.G., Chang T.W., Gurwith M. et al. (1978): Antibiotic-associated pseudomembranous colitis due to toxin-producing clostridia. -New Engl. J. Med., 298: 531–534.

    Article  CAS  Google Scholar 

  6. Bartlett J.G., Moon N., Chang T.W. et al. (1978): Role of Clostridium difficile in antibiotic-associated pseudomembranous colitis. -Gastroenterology, 75: 778–782.

    CAS  PubMed  Google Scholar 

  7. Bartlett J.G., Onderdonk A.B., Cisneros R.L. et al. (1977): Clindamycin associated colitis due to a toxin-producing species of Clostridium in hamsters. -J. Infect. Dis., 136: 701–705.

    Article  CAS  Google Scholar 

  8. Borriello S.P. (1983): Clostridium difficile and gut disease. In Microbes and Infections of the Gut, C.S. Goodwin Ed., Blackwell, London.

    Google Scholar 

  9. Brause B.D., Romankiewicz J.A., Gotz V. et al. (1980): Comparative study of diarrhea associated with clindamycin and ampicillin therapy. -Amer. J. Gastroenterol., 73: 244–248.

    CAS  Google Scholar 

  10. Brettle R.P., Poxton I.R., Murdoch J.McC. et al. (1982): Clostridium difficile in association with sporadic diarrhoea. -Br. Med. J., 284: 230–233.

    Article  CAS  Google Scholar 

  11. Burdon D.W. (1982): Clostridium difficile: The epidemiology and prevention of hospital-acquired infection. -Infection, 10: 203–204.

    Article  CAS  Google Scholar 

  12. Burdon D.W., George R.H., Mogg G. et al. (1981): Faecal toxin and severity of antibiotic-associated pseudomembranous colitis. -J. Clin. Pathol., 34: 548–551.

    Article  CAS  Google Scholar 

  13. Chang T.W., Bartlett J.G., Gorbach S.L. et al. (1978): Clindamycin-induced enterocolitis in hamsters as a model of pseudomembranous colitis in patients. -Infect. Immun., 20: 526–529.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Chang T.W., Lauernzan M. and Bartlett I.G. (1979): Cytotoxicity assay in antibiotic-associated colitis. -J. Infect. Dis., 140: 765–770.

    Article  CAS  Google Scholar 

  15. Cherry R., Portnoy D., Jabbari M. et al. (1982): Metronidazole: an alternate therapy for antibioticassociated colitis. -Gastroenterology, 82: 849–851.

    CAS  PubMed  Google Scholar 

  16. Ehric M., Van Tassell R.L., Libby J.M. and Wilkins T.D. (1980): Production of Clostridium difficile antitoxin. -Infect. Immun., 28 : 1041–1043.

    Google Scholar 

  17. Fekety R. (1979): Prevention and treatment of antibiotic associated colitis. - Microbiology, D. Schlessinger Ed., 276–279.

  18. Fekety R. (1983): Recent advances in management of bacterial diarrhoea. -Rev. Infect Dis., 5: 246–257.

    Article  CAS  Google Scholar 

  19. Fekety R., Kim K.H., Batts D.H. et al. (1980): Studies on the epidemiology of antibiotic-associated Clostridium difficile colitis. -Amer. J. Clin. Nutr., 33: 2523–2527.

    Article  Google Scholar 

  20. Fekety R., Kim K.H., Brown D. et al. (1981): Epidemiology of antibiotic associated colitis: isolation of Clostridium difficile from hospital environment. -Amer. J. Med., 70: 906–908.

    Article  CAS  Google Scholar 

  21. Fekety R., Silva J., Toshniwal R. et al. (1979): Antibiotic-associated colitis: effects of antibiotics on Clostridium difficile and the disease in hamsters. -Rev. Infect. Dis., 1: 386–397.

    Article  CAS  Google Scholar 

  22. George W.L. (1980): Antimicrobial agent-associated colitis and diarrhea. -West..J. Med., 133: 115–123.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. George W.L. (1984): Antimicrobial agent-associated colitis and diarrhea: historical background and clinical aspects. -Rev. Infect. Dis., 1: S208–213.

    Article  Google Scholar 

  24. George W.L., Rolfe R.D. and Finegold S.M. (1980): Treatment and prevention of antimicrobial agentinduced colitis and diarrhea. -Gastroenterology, 79: 366–372.

    CAS  PubMed  Google Scholar 

  25. George W.L., Rolfe R.D., and Finegold S.M. (1982): Clostridium difficile and its cytotoxin in feces of patients with antimicrobial agent-associated diar rhea and miscellaneous conditions. -J. Clin. Microbiol., 15: 1049–1053.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. George W.L., Sutter V.L., Goldstein J.C. et at. (1978): Aetiology of antimicrobial-agent-associated colitis. -Lancet, 1: 802–803.

    Article  CAS  Google Scholar 

  27. Gilligan P.H., McCarthy L.R. and Genta V.M. (1981): Relative frequency of Clostridium difficile in patients with diarrhoel disease. -J. Clin. Microbiol., 14: 26–31.

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Greenfield C., Szawathowski M., Noone P. et al. (1981): Is pseudomembranous colitis infectious? -Lancet, 1: 371–372

    Article  CAS  Google Scholar 

  29. Hawkins C.C., Buggy B.P., Fekety R. and Schaberg D.R. (1984): Epidemiology of colitis induced by Clostridiurn difficile in hamsters: application of a bacteriophage and bacteriocin typing system. -J. Infect. Dis., 149: 775–780.

    Article  CAS  Google Scholar 

  30. Kabins S.A. and Spira T.J. (1975): Outbreak of clindamvcin-associated colitis. -Ann. Intern. Med., 83: 830–831.

    Article  CAS  Google Scholar 

  31. Kim K.H., Dupont H.L. and Pickering L.K. (1983): Outbrears of diarrhea associated with Clostridium difficile and its toxin in day-care centers: evidence of person-to-person spread. -J. Pediat., 102: 376–382.

    Article  CAS  Google Scholar 

  32. Kim K.H., Fekety R., Batts D.H. et al. (1981): Isolation of Clostridium difficile from the environment and contacts of patients with antibioticassociated colitis. -J. Infect. Dis., 143: 42–50.

    Article  CAS  Google Scholar 

  33. Larson H.E., Parry J.V., Price A.B. et al. (1977): Undescribed toxin in pseudomembranous colitis. -Br. Med. J., 1: 1246–1248.

    Article  CAS  Google Scholar 

  34. Larson H.E. and Price A.B. (1977): Pseudomembranous colitis: presence of clostridial toxin. -Lancet, 2, 1312–1314.

    Article  CAS  Google Scholar 

  35. Larson H.E., Price A.B., Honour P. et al. (1978): Clostridium difficile and the aetiology of pseudomembranous colitis. -Lancet, 1: 1063–1066.

    Article  CAS  Google Scholar 

  36. Lishman A.H., Al-Jumaili I.J. and Record C.O. (1981): Spectrum of antibiotic-associated diarrhea. -Gut, 22, 34–38.

    Article  CAS  Google Scholar 

  37. Malamou-Ladas H., O'Farrell S., Nash J.Q. and Tabaqchali S. (1943): Isolation of Clostridium difficile from patients and the environment of hospital wards. -J. Clin. Pathol., 36: 88–92.

    Article  Google Scholar 

  38. McKinley M.J., Troncale F., Sangree M.H. et al. (1982): Antibiotic-associated colitis: clinical and epidemiological features. -J. Gastroenterol., 77: 77–81.

    CAS  Google Scholar 

  39. Milligan D.W. and Kelly J.K. (1979): Pseudomembranous colitis in a leukemia unit: a report of five fatal cases. -J. Clin. Pathol., 32: 1237–1243.

    Article  CAS  Google Scholar 

  40. Mulligan M.E., George W.L., Rolfe R.D. and Finegold S.M. (1980): Epidemiological aspects of Clostridium difficile-induced diarrhea and colitis. -Amer. J, Clin. Nutr., 33: 2533–2538.

    Article  CAS  Google Scholar 

  41. Mulligan M.E., Rolfe R.D., Finegold S.M. and George W.L. (1979): Contamination of a hospital environment by Clostridiann difficile. -Curr, Microbiol., 3: 173–175.

    Article  Google Scholar 

  42. Nakamura S., Mikawa M., Nakashio S. et al. (1981): Isolation of Clostridium difficile from feces and the antibody in sera of young and elderly adults. -Microbiol. Immunol., 25: 345–348.

    Article  CAS  Google Scholar 

  43. Nash J.Q. Chattopadhyay B., Honeycombe J. and Tabaqchali S. (1982): Clostridium difficile and cytotoxin in routine faecal specimens. -J. Clin. Pathol., 35: 561–565.

    Article  CAS  Google Scholar 

  44. Pierce P.F. Jr., Wilson R., Silva J. Jr. et al. (1982): Antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases. -J. Infect. Dis., 145: 269–274.

    Article  Google Scholar 

  45. Ratliff W. (1976): Assembly Language Relational Database Management System, Ashton Tate, Culver City.

  46. Rifkin G.D., Fekety R.F., Silva J. and Sack R.B. (1977): Antibiotic-induced colitis: implications of toxin neutralized by Clostridium sordelli antitoxin. -Lancet, 2: 1103–1106.

    Article  CAS  Google Scholar 

  47. Ritchie D.B., Jennings L.C., Lynn K.L. et al. (1982): Clostridium difficile associated colitis: cross infection in predisposed patients with renal failure. -New Zealand Med. J., 95: 265–268.

    PubMed  Google Scholar 

  48. Rogers T.R., Petrou M., Lucas C. et al. (1981): Spread of Clostridium difficile among patients receiving non absorbable antibiotics for gut decontamination, -Brit. Med. J., 283: 408–409.

    Article  CAS  Google Scholar 

  49. Rolfe R.D. and Iaconis J.P. (1983): Intestinal colonization of infant hamsters with Clostridium difficile. -Infect. Immun., 42: 480–486.

    CAS  PubMed  PubMed Central  Google Scholar 

  50. Rosenberg J.M., Walker M., Welch J.P. and Mullany L. (1984): Clostridium difficile colitis in surgical patients. -Amer. J. Surg., 147: 486–491.

    Article  CAS  Google Scholar 

  51. Sell T.L., Schaberg D.R. and Fekety F.R. (1983): Bacteriophage and bacteriocin typing scheme for Clostridium difficile. -J. Clin. Microbiol., 17: 1148–1152.

    CAS  PubMed  PubMed Central  Google Scholar 

  52. Silva J. Jr. (1979): Animal models of antibiotic-induced colitis. - Microbiology. D. Schlessinger Ed., 258–263.

  53. Silva J. (1984): Antibiotic-associated colitis. -West. J. Med., 140: 275–276.

    PubMed  PubMed Central  Google Scholar 

  54. Stergachis A., Perera D.R., Schnell M.M. and Jick H., (1984): Antibiotic-associated colitis. -Clin. Invest., 140: 217–219.

    CAS  Google Scholar 

  55. Tabaqchali S., Holland D., O'Farrell S. and Silman R. (1984): Typing scheme for Clostridium difficile: its application in clinical and epidemiological studies. -Lancet, 1: 935–938.

    Article  CAS  Google Scholar 

  56. Tedesco F.J., Barton R.W. and Alpers D.H. (1974): Clindamycin-associated colitis: a prospective study. -Ann. Intern. Med., 81: 429–433.

    Article  CAS  Google Scholar 

  57. Urbano P., Gargani G., Dei R. and LeBrun S. (1983): Implicazione del Clostridium difficile in un grosso focolaio di coliti nosocomiali. -Boll. Epidemiol. Naz., 24: 1–3.

    Google Scholar 

  58. Urbano P., Gargani G., Dei R. et al. (1983): Implication of Clostridium difficile in a large outbreak of nosocomial diarrhoeas. - First Europ. Congr. Clin. Microbiol, (abstract), Bologna.

  59. Urbano P. (1984): Considerazioni sul ruolo eziologico di Clostridium difficile. -Igiene Moderna, 81: 1046–1058.

    Google Scholar 

  60. Urbano P., Gargani G., Dei R. et al. (1984): Indagini su una divisione chirurgica con forte endemia di coliti da Clostridium difficile.: Risultati preliminari dopo un anno di sorveglianza eziologica. -V Conv. Naz. di Microbiol. Clin., Napoli.

  61. Urbano P., Le Brun S. and De F'rancesco F. (1984): Antibiotic-associated diarrhoeas in a surgical division hyperendemic for Clostridium difficile. - 4th Mediterr. Congr. Chemother., Rhodes.

  62. Varki N.M. and Aquino T.I. (1982): Isolation of Clostridium difficile from hospitalized patients without antibiotic-associated diarrhea or colitis. -J. Clin. Microbiol., 16: 659–662.

    CAS  PubMed  PubMed Central  Google Scholar 

  63. Viscidi R., Laughon B.E., Yolken R. et al. (1983): Serum antibody response to toxins A and B of Clostridium difficile. -J. Infect. Dis., 148: 93–100.

    Article  CAS  Google Scholar 

  64. Viscidi R., Willey S. and Bartlett J.G. (1981): isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations. -Gastroenterology, 81: 5–9.

    CAS  PubMed  Google Scholar 

  65. Walters B.A., Stafford R., Roberts R.K. and Seneviratne E. (1982): Contamination and cross infection with Clostridium difficile in an intensive care unit. -New Zealand J. Med., 12: 255–258.

    Article  CAS  Google Scholar 

  66. Wilson K.H. (1983): Efficiency of various bile salt preparations for stimulation of Clostridium difficile spore germination. -J. Clin. Microbiol., 18: 1017–1019.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Wilson K.H., Kennedy M.J. and Fekety F.R. (1982): Use of sodium taurocholate to enhance spore recovery on a medium selective for Clostridium difficile. -J. Clin. Microbiol., 15: 443–448.

    CAS  PubMed  PubMed Central  Google Scholar 

  68. Wüst J., Sullivan N.M., Hardegger U. and Wilkins T. (1982): Investigation of an outbreak of antibiotic-associated colitis by various typing methods. -J. Clin. Microbiol., 16: 1096–1101.

    PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Istituto di Microbiologia, Università di Firenze, Viale Morgagni 48, 50134, Firenze, Italy

    P. Urbano

  2. Unità Sanitaria Locale 22, Valtiberina, Via Matteotti 10, 52037, Sansepolcro (Arezzo), Italy

    S. Le Brun

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  1. P. Urbano
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  2. S. Le Brun
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Urbano, P., Le Brun, S. Nosocomial diarrhoeas in a surgical division hyperendemic for Clostridiuni difficile: Epidemiologic aspects emerging from an analysis of clinical records. Eur J Epidemiol 2, 272–281 (1986). https://doi.org/10.1007/BF00419491

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