Prevalence of Clostridium difficile Toxins A and B and Clostridium perfringens Enterotoxin A in Stool Samples of Patients with Antibiotic–Associated Diarrhea

Abstract

Background:

Antibiotic–associated diarrhea (AAD) is a major nosocomial as well as a community health problem. Clostridium difficile toxins (CDT) can be detected in only 10–25% of patients with AAD. The role of Clostridium perfringens enterotoxin A (CPEnt) as a cause of AAD remains to be elucidated. We, therefore, prospectively investigated the prevalences of both CPEnt and CDT in stool samples of patients with AAD.

Materials and Methods:

A total of 693 stool samples consecutively submitted to our department from patients with AAD were screened for CDT and CPEnt using commercially available enzyme–linked immunoassays (ELISA). C. difficile and C. perfringens were detected by standard culture techniques. In addition, samples being CPEnt positive and/ or harboring C. perfringens were screened for the CPEnt gene by duplex PCR.

Results:

CDT was detected in 79 (11.4%) of 693 stool samples. Of these, 49 (62.0%) harbored C. difficile. In one (0.14%) of 693 samples, CPEnt could be detected by ELISA. This respective CPEnt–positive stool sample also harbored C. perfringens. 147 (21.2%) of all stool samples were culture positive for C. perfringens. We did not detect samples positive for both CPEnt and CDT. In five (3.4%) of 147 C. perfringens isolates, the CPEnt gene could be detected by duplex PCR. PCR was positive in two (40%) of the five stool samples harboring CPEnt gene–positive C. perfringens isolates.

Conclusion:

The present prospective study revealed a prevalence of CDT of 11.4%, whereas the prevalence of CPEnt was less than 1%. Routine screening of stool samples for CPEnt does not appear to be justified in patients with AAD.