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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

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Abstract

Patients hospitalized in a hospital with a high incidence of antibiotic-associated diarrhea due to toxin A-negative, toxin B-positive (A−/B+) Clostridium difficile were retrospectively investigated to determine the clinical manifestations and risk factors for infection. Of 77 Clostridium difficile isolates obtained from 77 patients during the 1-year investigation period, 30 were A−/B+ and 47 were toxin A-positive, toxin B-positive (A+/B+). By pulsed-field gel electrophoresis analysis, 23 of the 30 A−/B+ strains were outbreak-related, suggesting nosocomial spread of a single type of bacterium, which mainly affected patients in the wards of respiratory medicine, hematology and neurology. Using regression analysis, three factors were found to be associated with infection by A−/B+ isolates: (i) exposure to antineoplastic agents (P=0.01, odds ratio [OR]=5.1), (ii) the use of nasal feeding tubes (P=0.008, OR=5.2), and (iii) assignment to a certain internal medicine ward (P=0.05, OR=3.0). Between patients with Clostridium difficile-associated diarrhea caused by A−/B+ strains and those with A+/B+ strains, no statistically significant difference was found in body temperature, serum concentration of C-reactive protein, leukocyte count in whole blood, frequency of diarrhea, or type of underlying disease. These results indicate that A−/B+ strains of Clostridium difficile can cause intestinal infection in humans and they spread nosocomially in the same manner as A+/B+ strains.

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Authors and Affiliations

  1. Division of Clinical Microbiology, Department of Clinical Pathology, Tenri Hospital, 200 Mishima, Tenri, Nara 632-8552, Japan

    M. Komatsu, M. Aihara, K. Shimakawa, M. Iwasaki, Y. Nagasaka, S. Fukuda & S. Matsuo

  2. Division of Laboratory Science, Course of Health Science, Graduate School of Medicine, Osaka University, 1–7 Yamadaoka, Suita, Osaka 565-0871, Japan

    M. Komatsu, M. Watanabe & Y. Iwatani

  3. Department of Bacterial Pathogenesis and Infection Control, National Institute of Infectious Diseases, Musashimurayama, Tokyo 208-0011, Japan

    H. Kato & Y. Arakawa

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  1. M. Komatsu
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  2. H. Kato
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  3. M. Aihara
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  4. K. Shimakawa
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  5. M. Iwasaki
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  6. Y. Nagasaka
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  7. S. Fukuda
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  8. S. Matsuo
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  9. Y. Arakawa
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  10. M. Watanabe
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  11. Y. Iwatani
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Correspondence to M. Komatsu.

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Komatsu, M., Kato, H., Aihara, M. et al. 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 (2003). https://doi.org/10.1007/s10096-003-0992-5

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  • DOI: https://doi.org/10.1007/s10096-003-0992-5

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