European Journal of Pediatrics

, Volume 147, Issue 1, pp 36–40 | Cite as

Clostridium difficile in neonates: serogrouping and epidemiology

  • M. Delmée
  • G. Verellen
  • V. Avesani
  • G. Francois
Original Investigations


A typing scheme for clostridium difficile based on serogrouping, toxigenicity and sorbitol fermentation was applied to 270 strains isolated in one neonatal ward during a 6-month prospecitive study. Two hundred and twenty-three strains were isolated from 377 faecal samples of 114 neonates and 47 from 92 environmental specimens. The isolates were distributed among five different types; 87% of the faecal and 85% of the environmental isolates belonged to two of these types (toxigenic, sorbitol negative, serogroup F and nontoxigenic, sorbitol positive, serogroup A). Nosocomial spread was clearly demonstrated and the environment appeared to be the main source of contamination: most of the neonates were colonized after admission by strains found in their environment; clusters of colonization with unusual isolates were observed following referral of patients from the intensive care unit or from other hospitals. No relation was found between the acquisition or the carriage of C. difficile and any intestinal symptoms. All the strains belonged to types different from those usually found in cases of antibiotic associated colitis (AAC) suggesting differences of pathogenicity among the different types.

Key words

Clostridium difficile 



pseudomembranous colitis


antibiotic associated colitis


antibiotic associated diarrhoea


taurocholate cycloserin cefotaxim fructose agar


intensive care unit


sodium dodecyl sulphate-polyacrylamide gel electrophoresis


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  1. 1.
    Bartlett JG, Chang TW, Gurwith SL, Gorbach SL, Onderdonk AB (1978) Antibiotic-associated pseudomembranous colitis due to toxin producing clostridia. N Engl J Med 298:531–534Google Scholar
  2. 2.
    Bender BS, Laughon BE, Gaydos C, Forman MS, Bennett R, Greenhough WB III, Sears SD, Bartlett JG (1986) Is Clostridium difficile endemic in chronic-care facilities? Lancet II:11–13Google Scholar
  3. 3.
    Bolton RP, Tait SK, Dear PR, Losowsky MS (1984) Asymptomatic neonatal colonisation by clostridium difficile. Arch Dis Child 59:466–472Google Scholar
  4. 4.
    Borriello SP, Barclay FE (1985) Protection of hamsters against Clostridium difficile ileocaecitis by prior colonisation with nonpathogenic strains. J Med Microbiol 19:339–350Google Scholar
  5. 5.
    Delmée M, Michaux JL (1986) Prevention of Clostridium difficile outbreaks in hospitals. Lancet II:350Google Scholar
  6. 6.
    Delmée M, Homel M, Wauters G (1985) Serogrouping of clostridium difficile by slide agglutination. J Clin Microbiol 21:323–327Google Scholar
  7. 7.
    Delmée M, Bulliard G, Simon G (1986) Application of a technique for serogrouping Clostridium difficile in an outbreak of antibiotic-associated diarrhoea. J Infect 13:5–9Google Scholar
  8. 8.
    Donta ST, Myers MG (1982) Clostridium difficile in asymptomatic neonates. J Pediatr 100:431–434Google Scholar
  9. 9.
    George WL, Sutter VL, Citron D, finegold SM (1979) Selective and differential medium for isolation of Clostridium difficile. J Clin Microbiol 9:214–219Google Scholar
  10. 10.
    Hafiz S, Oakley CL (1976) Clostridium difficile: isolation and characteristics. J Med Microbiol 9:129–136Google Scholar
  11. 11.
    Haslam SC, Ketley JM, Mitchell TJ, Stephen J, Burdon DW, Candy DCA, (1986) Growth of Clostridium difficile and production of toxin A and B in complex and defined media. J Med Microbiol 21:293–297Google Scholar
  12. 12.
    Heard SR, O'Farrell S, Holland D, Crook S, Barnett MJ, Tabaqchali S (1986) The epidemiology of clostridium difficile with use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients. J Infect Dis 153:159–162Google Scholar
  13. 13.
    Larson HE, Barclay FE, Honour P, Hill ID (1982) Epidemiology of Clostridium difficile in infants. J Infect Dis 146:727–733Google Scholar
  14. 14.
    Mandal BK, Watson B, Ellis M (1982) Pseudomembranous colitis in a 5-week-old infant. Br Med J 284:345–346Google Scholar
  15. 15.
    Miller SD, Koornhof HJ (1984) Clostridium difficile colitis associated with the use of antineoplastic agents. Eur J Clin Microbiol 3: 10–13Google Scholar
  16. 16.
    Richardson SA, Alcock PA, Gray J (1983) Clostridium difficile and its toxin in healthy neonates. Br Med J 287:878Google Scholar
  17. 17.
    Sherertz RJ, Sarubbi FA (1982) The prevalence of Clostridium difficile and toxin in a nursery population: a comparison between patients with necrotizing enterocolitis and an asymptomatic group. J Pediatr 100:435–439Google Scholar
  18. 18.
    Sutphen JL, Grand RJ, FLores A, Chang TW, bartlett JG (1983) Chronic diarrhoea associated with clostridium difficile in children. Am J Dis Child 137:275–278Google Scholar
  19. 19.
    Tabaqchali S, Holland D, O'Farrell S, Silman R (1984) Typing scheme for Clostridium difficile: its application in clinical and epidemiological studies. Lancet I:935–938Google Scholar
  20. 20.
    Vesikari T, Isolauri E, Maki M, Gronroos P (1984) Clostridium difficile in young children. Association with antibiotic usage. Acta Paediatr Scand 73:86–91Google Scholar
  21. 21.
    Welch DF, Marks MI (1982) Is Clostridium difficile pathogenic in infants? J Pediatr 100:393–395Google Scholar
  22. 22.
    Willey SH, Bartlett JG (1979) Cultures for Clostridium difficile in stools containing a cytotoxin neutralized by Clostridium sordellii antiserum. J Clin Microbiol 10:880–884Google Scholar
  23. 23.
    wilson KH, Sheagren JN (1983) Antagonism of toxigenic Clostridium difficile by nontoxigenic C. difficile. J Infect Dis 147:733–736Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • M. Delmée
    • 1
  • G. Verellen
    • 1
  • V. Avesani
    • 1
  • G. Francois
    • 1
  1. 1.Microbiology Unit and Department of PediatricsUniversity of LouvainBrusselsBelgium

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