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Use of pulsed-field gel electrophoresis for investigation of an outbreak ofClostridium difficile infection among geriatric patients

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Abstract

A six-month outbreak ofClostridium difficile infection among elderly residents of a middle-term-care facility was investigated. Pulsed-field gel electrophoresis was used to genotype 22 outbreak strains and 30 epidemiologically unrelated strains. A prospective case-control study was conducted to identify risk factors for epidemicClostridium difficile-associated diarrhea. All epidemiologically unrelatedClostridium difficile strains of the same serogroup could be differentiated by their DNA patterns with two restriction enzymes (Smal andKspl). Among clustered strains, two epidemic serogroups (C and K) were identified. Two different DNA patterns were identified among serogroup C strains and three among serogroup K strains. Multivariate analysis showed that the risk ofClostridium difficile infection increased with antimicrobial chemotherapy (β-lactam agents and pristinamycin) and the presence of a feeding tube. This study confirms the high discriminative power of restriction fragment length polymorphism analysis by pulsed-field gel electrophoresis to describeClostridium difficile epidemiology. The typing results confirm that infection was principally exogenous in this outbreak. Furthermore, they indicate the need to improve all measures limiting transmission of infection.

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References

  1. Bartlett JG: Antibiotic associated diarrhea. Clinical Infectious Diseases 1992, 15: 573–581.

    PubMed  Google Scholar 

  2. Lyerly DM, Krivan HC, Wilkins TD:Clostridium difficile: its disease and toxins. Clinical Microbiology Reviews 1988, 1: 1–18.

    PubMed  Google Scholar 

  3. Mulligan ME, Rolfe RD, Finegold M, George WL: Contamination of hospital environment byClostridium difficile. Current Microbiology 1979, 3: 173–175.

    Google Scholar 

  4. Testore GP, Pantosti A, Cerquetti M, Babudieri S, Panichi G, Gianfrilli PM: Evidence for cross-infection in an outbreak ofClostridium difficile-associated diarrhea in a surgical unit. Journal of Medical Microbiology 1988, 26: 125–128.

    PubMed  Google Scholar 

  5. Delmée M, Michaux JL: Prevention ofClostridium difficile outbreaks in hospitals. Lancet 1986, ii: 350.

    Google Scholar 

  6. Kim K, Dupont HL, Pickering LK: Outbreaks of diarrhea associated withClostridium difficile and its toxin in daycare centers: evidence of person-to-person spread. Journal of Pediatrics 1983, 102: 376–382.

    PubMed  Google Scholar 

  7. McFarland LV, Surawicz CM, Stamm WE: Risk factors forClostridium difficile carriage andC. difficile-associated diarrhea in a cohort of hospitalized patients. Journal of Infectious Diseases 1990, 162: 678–684.

    PubMed  Google Scholar 

  8. Chachaty E, Depitre C, Mario N. Bourneix C, Saulnier P, Corthier G, Andremont A: Presence ofClostridium difficile and antibiotic and β-lactamase activities in feces of volunteers treated with oral cefixime, oral cefpodoxime proxetil, or placebo. Antimicrobial Agents and Chemotherapy 1992, 36: 2009–2013.

    PubMed  Google Scholar 

  9. Samore MH, DeGirolami PC, Tlucko A, Lichtenberg DA, Melvin ZA, Karchmer AW:Clostridium difficile colonization and diarrhea at a tertiary care hospital. Clinical Infectious Diseases 1994, 18: 181–187.

    PubMed  Google Scholar 

  10. Simor AE, Yake SL, Tsimidis K: Infection due toClostridium difficile among elderly residents of a long-term-care facility. Clinical Infectious Diseases 1993, 17: 672–678.

    PubMed  Google Scholar 

  11. Delmée M, Homel M, Wauters G: Serogrouping ofClostridium difficile strains by slide agglutination. Journal of Clinical Microbiology 1985, 21: 323–327.

    PubMed  Google Scholar 

  12. Delmée M, Avesani V, Ernest I, Surleraux M: Characterization ofClostridium difficile flagellar antigen and their role in serogrouping reaction. Journal of Clinical Microbiology 1990, 28: 2210–2214.

    PubMed  Google Scholar 

  13. Tabaqchali S, O'Farrell S, Holland D, Silman R: Method for the typing ofClostridium difficile based on polyacrylamide gel electrophoresis of 35S-methionine labeled proteins. Journal of Clinical Microbiology 1986, 23:197–198.

    PubMed  Google Scholar 

  14. Sell TL, Schaberg DR, Fekety FR: Bacteriophage and bacteriocin typing scheme forClostridium difficile. Journal of Clinical Microbiology 1983, 17: 1148–1152.

    PubMed  Google Scholar 

  15. Wust J, Sullivan NM, Hardegger U, Wilkins TD: Investigation of an outbreak of antibiotic-associated colitis by various typing methods. Journal of Clinical Microbiology 1982, 16: 1096–1101.

    PubMed  Google Scholar 

  16. Kuijper EJ, Oudbier JH, Stuifbergen WNHM, Jansz A, Zanen HC: Application of whole-cell DNA restriction endonuclease profile to the epidemiology ofClostridium difficile-induced diarrhea. Journal of Clinical Microbiology 1987, 25: 751–753.

    PubMed  Google Scholar 

  17. Wilson KH, Blitchington R, Hindenach B, Greene RC: Species-specific oligonucleotide probes for rRNA ofClostridium difficile and related species. Journal of Clinical Microbiology 1988, 26: 2484–2488.

    PubMed  Google Scholar 

  18. Silva J, Tang YJ, Gumerlock PH: Genotyping ofClostridium difficile isolates. Journal of Infectious Diseases 1994, 169: 661–664.

    PubMed  Google Scholar 

  19. George WL, Sutter VL, Citron D, Finegold SM: Selective and differential medium for isolation ofClostridium difficile. Journal of Clinical Microbiology 1979, 9: 214–219.

    PubMed  Google Scholar 

  20. Holdeman LV, Cato EP, Moore WEC (ed): Anaerobe laboratory manual. 4th edition. Virginia Polytechnic Institute and State University, Blacksburg, WV, 1977, p. 98.

    Google Scholar 

  21. Donta ST, Shaffer SJ: Effects ofClostridium difficile toxin on tissue-cultured cells. Journal of Infectious Diseases 1980, 141: 218–222.

    PubMed  Google Scholar 

  22. Hunter PR: Reproducibility and indices of discriminatory power of microbial typing methods. Journal of Clinical Microbiology 1990, 28: 1903–1905.

    PubMed  Google Scholar 

  23. DuPont HL, Ribner BS: Infectious gastroenteritis. In: Bennet JV, Brachman PS (ed): Hospital infections. 3rd edition. Little, Brown, Boston, 1992, p. 641–658.

    Google Scholar 

  24. Mahony DE, Clow J, Atkinson L, Vakharia N, Schlech WF: Development and application of a multiple typing system forClostridium difficile. Applied and Environmental Microbiology 1991, 57: 1873–1879.

    PubMed  Google Scholar 

  25. Mulligan ME, Peterson LR, Kwok RYY, Clabots CR, Gerding DN: Immunoblots and plasmid fingerprints compared with serotyping and polyacrylamide gel electrophoresis for typingClostridium difficile. Journal of Clinical Microbiology 1988, 26: 41–46.

    PubMed  Google Scholar 

  26. Barbut F, Mario N, Delmée M, Gozian J, Petit JC: Genomic fingerprinting ofClostridium difficile isolates by using a random amplified polymorphic DNA (RAPD) assay. FEMS Microbiology Letters 1993, 114: 161–166.

    PubMed  Google Scholar 

  27. Pierce PF Jr, Wilson R, Silva J Jr, Garagusi VF, Rifkin GD, Fekety R, Nunez-Montiel O, Doweil VR Jr, Hughes JM: Antibiotic-associated pseudomembranous colitis: an epidemiologic investigation of a cluster of cases. Journal of Infectious Diseases 1982, 145: 269–274.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Laboratoire de Bactériologie-Hygiène, Faculté de Médecine, Hôpital Jean Minjoz, Bd. Fleming, 25030, Besançon, France

    D. Talon, P. Bailly, M. Thouverez, B. Mulin, V. Cailleaux & Y. Michel-Briand

  2. Unité de Microbiologie, Université de Louvain, Brussels, Belgium

    M. Delmée

  3. Centre de soins des Tilleroyes, Besançon, France

    M. Iehl-Robert

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  1. D. Talon
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  2. P. Bailly
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  3. M. Delmée
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  4. M. Thouverez
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  5. B. Mulin
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  6. M. Iehl-Robert
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  7. V. Cailleaux
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  8. Y. Michel-Briand
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Talon, D., Bailly, P., Delmée, M. et al. Use of pulsed-field gel electrophoresis for investigation of an outbreak ofClostridium difficile infection among geriatric patients. Eur. J. Clin. Microbiol. Infect. Dis. 14, 987–993 (1995). https://doi.org/10.1007/BF01691381

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