Skip to main content
SpringerLink
Log in

Occurrence of toxin-producingClostridium difficile in antibiotic-associated diarrhea in Sweden

  • Published:
Medical Microbiology and Immunology Aims and scope Submit manuscript

Abstract

From 1324 patients with antibiotic-associated diarrhea (AAD) 1643 stool samples were analyzed by a cell test forClostridium difficile toxin in stool filtrates and cultivation for occurrence ofC. difficile strains. In patients with no detectable toxin in their stool strains ofC. difficile were isolated in 2.2% where as when toxin was detectable, the isolation rate varied from 17% to 36%.

Furthermore, there was a correlation between toxin titre in stool filtrate and production of cytotoxinin vitro by the correspondingC. difficile strains. Five clostridial strains, not belonging to the speciesC. difficile, were found to produce typical cytotoxinin vitro. However, five strains identified asC. difficile by biochemical reactions and gas liquid chromatography, did not produce an extracellular cytotoxin. The antibiotic susceptibility patterns of theClostridium strains were investigated. No correlation was recognized between antibiotic resistance of isolatedClostridium strains and the AAD-inducing antibiotic penicillins and linco/clindamycin. Neither did cases of relapse of diarrheal disease after vancomycin treatment harbourC. difficile strains with increased resistance to vancomycin. It is concluded that the pathogenesis of antibiotic-associated enterocolitis is more complex than a mere intestinal overgrowth of resistant strains ofC. difficile.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Bartlett JG (1979) Antibiotic-associated pseudomembranous colitis. Rev Infect Dis 1: 530–539

    PubMed  Google Scholar 

  • Bartlett JG (1980) In: Kallings LO, Möllby R, Nord CE (eds) Antibiotic-associated colitis andClostridium difficile. Scand J Inf Dis Suppl 22:47

    Google Scholar 

  • Bolton RP, Sheriff RJ, Read AE (1980)C. difficile associated diarrhoea. A role in inflammatory bowel disease? Lancet 1:383–384

    Article  PubMed  Google Scholar 

  • Burdon DW, Brown JD, Youngs DJ, Arabi Y, Shinagawa N, Alexander-Williams J, Keighley MRB (1979) Antibiotic susceptibility ofC. difficile. J Antimicrob Chemother 5:307–310

    PubMed  Google Scholar 

  • Chang TW, Gorbach SL, Bartlett JB (1978) Neutralization ofClostridium difficile toxin byClostridium sordelli antitoxins. Infect Immun 22:418–422

    PubMed  Google Scholar 

  • Dornbusch K, Nord CE, DahlbÄck A (1975) Antibiotic susceptibility ofClostridium species isolated from human infections. Scand J Inf Dis 7:127–134

    Google Scholar 

  • Dzink J, Bartlett JG (1980)In vitro susceptibility ofC. difficile isolates from patients with antibiotic-associated diarrhea or colitis. Antimicrob Agents Chemother 17: 695–698

    PubMed  Google Scholar 

  • Ellner PD (1956) A medium promoting rapid quantitative sporulation inClostridium perfringens. J Bacteriol 71:495–496

    PubMed  Google Scholar 

  • Eriksson S (1980) Antibiotic induced pseudomembranous colitis. LÄkartidningen 30/31: 2630–2631

    Google Scholar 

  • Falsen E, Kaijser B, Nehls L, Nygren B, Svedhem å (1980)C. difficile in relation to enteric bacterial pathogens. J Clin Microbiol 12:297–300

    PubMed  Google Scholar 

  • Fekety R, Silva J, Toshniwal R, Allo M, Armstrong J, Browne R, Ebright J, Riwkin G (1979) Antibiotic-associated colitis: Effect of antibiotics onC. difficile and the disease in hamster. Rev Inf Dis 1:386–396

    Google Scholar 

  • Fekety R, Kim KH, Brown D, Batts DH, Cudmore MA, Silva J (1980) Epidemiology of antibiotic associated colitis: Isolation ofClostridium difficile from hospital environment. Int Conf on Nosocomial Infections, Atlanta Aug 5–8

  • George RH, Symonds JM, Dimock F, Brown JD, Arabi Y, Shinagawa N, Keighley MRB, Alexander-Williams J, Burdon DW (1978) Identification ofC. difficile as a cause of pseudomembranous colitis. Brit Med J 1:695

    PubMed  Google Scholar 

  • George WL, Sutter VL, Finegold SM (1977) Antimicrobial agent-induced diarrhoea — a bacterial disease. J Inf Dis 136:822–828

    Google Scholar 

  • George WL, Sutter VL, Finegold SM (1978) Toxigenicity and antimicrobial susceptibility ofC. difficile — a cause of antimicrobial agent-associated colitis. Curr Microbiol 1:55–58

    Google Scholar 

  • George WL, Sutter VL, Citron D, Finegold SM (1979) Selective and differential medium for isolaton ofC. difficile. J Clin Microbiol 9:214–219

    PubMed  Google Scholar 

  • George WL, Kirby BD, Sutter VL, Finegold SM (1979) Antimicrobial susceptibility ofClostridium difficile. In: Schlessinger D (ed) Microbiology — 1979. American Society for Microbiology, Washington, USA

    Google Scholar 

  • Greenfield C, Szawathowski M, Noone P, Burroughs A, Bass N, Pounder R (1981) Is pseudomembranous colitis infectious? Lancet 1:371–372

    Article  PubMed  Google Scholar 

  • Hall IC, O'Toole E (1935) Intestinal flora in new-born infants with a description of a new pathogenic anaerobe,Bacillus difficilis. Am J Dis Child 49:390–402

    Google Scholar 

  • Holdeman V, Cato EP, Moore WEC (1977) Anaerobe Laboratory Manual 4th ed. Virginia Polytechnic Institute and State University, Blacksburg

    Google Scholar 

  • Holst E, Helin I, Mårdh P-A (1981) Recovery ofClostridium difficile from children. Scand J Infect Dis 13:41–45

    PubMed  Google Scholar 

  • Ionesco H (1980) Transfer de la résistance à la tétracycline chezClostridium difficile. Ann Microbiol (Inst Pasteur) 131 A:171–179

    Google Scholar 

  • Howard JM, Sullivan SN, Troster M (1980) Spontaneous pseudomembranous colitis. Brit Med J 281:356

    Google Scholar 

  • Kabins SA, Spira TJ (1975) Outbreak of clindamycin-associated colitis (letter). Ann Intern Med 83:830–831

    PubMed  Google Scholar 

  • Keighley MRB, Burdon DW, Mogg GAG, George RH, Alexander-Williams J, Thompson H (1979) Pseudomembranous colitis (letter). Lancet 1:559–560

    Article  Google Scholar 

  • Knoop FC (1979) Clindamycin-associated enterocolitis in guinea pigs: evidence for a bacterial toxin. Infect immun 23:31–33

    PubMed  Google Scholar 

  • LaMont TJ, Sonnenblick EB, Rothman S (1979) Role of clostridial toxin in the pathogenesis of clindamycin colitis in rabbits. Gastroenterology 76:356–361

    PubMed  Google Scholar 

  • Lamont JT, Trnka YM (1980) Therapeutic implications ofC. difficile toxin during relapse of chronic inflammatory bowel disease. Lancet 1:381–383

    Article  PubMed  Google Scholar 

  • Larson HE, Price AB, Honour P, Borrelio SP (1978)Clostridium difficile and the etiology of pseudomembranous colitis. Lancet 1:1063–1066

    Article  PubMed  Google Scholar 

  • Larson HE (1979) Pseudomembranous colitis is an infection. J Infect 1:221–226

    Article  Google Scholar 

  • Larson HE, Price AB, Borrelio SP (1980) Epidemiology of experimental enterocolitis due toClostridium difficile. J Inf Dis 142:408–413

    Google Scholar 

  • Möllby R, Nord CE, Aronsson B (1980) Diagnosis ofC. difficile associated enterocolitis in Sweden. Laboratory and epidemiological aspects. Scand J Inf Dis Suppl 22:30–36

    Google Scholar 

  • Nord CE, Heimdahl A (1979) Effect of phenoximethylpenicillin and clindamycin on the oral, throat and faecal microflora of man. Scand J Inf Dis 11:233–242

    Google Scholar 

  • Peikin SR, Galdibini J, Bartlett JG (1980) Role ofC. difficile in a case of non-antibiotic -associated pseudomembranous colitis. Gastroenterology 79:948–951

    PubMed  Google Scholar 

  • Rampling A, Everett WG, Sills OA (1980)Clostridium difficile and chronic inflammatory bowel disease. Lancet 1:714–715 (1980)

    Google Scholar 

  • Rehg JE (1980) Cecal toxin(s) from guinea pigs with clindamycin-associated colitis, neutralized by clostridium sordellii antitoxin. Infect Immun 27:387–390

    PubMed  Google Scholar 

  • Scott AJ, Nicholson GI, Kerr A (1973) Lincomycin as a cause of pseudomembranous colitis. Lancet 1:1232–1234

    Article  PubMed  Google Scholar 

  • Shuttleworth R, Taylor M, Jones DM (1980) Antimicrobial susceptibilities ofClostridium difficile. J Clin Path 33:1002–1005

    PubMed  Google Scholar 

  • Thelestam M, Brönnegård M (1980) Interaction of cytopathogenic toxin fromClostridium difficile with cells in tissue culture. Scand J Inf Dis Suppl 22:16–29

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Bacteriology, National Bacteriological Laboratory, S-105 21, Stockholm

    B. Aronsson, R. Möllby & C. E. Nord

  2. Department of Infectious Diseases, Karolinska Institute, Roslagstull Hospital, Box 5651, S-114 89, Stockholm, Sweden

    B. Aronsson, R. Möllby & C. E. Nord

Authors
  1. B. Aronsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Möllby
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. E. Nord
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Aronsson, B., Möllby, R. & Nord, C.E. Occurrence of toxin-producingClostridium difficile in antibiotic-associated diarrhea in Sweden. Med Microbiol Immunol 170, 27–35 (1981). https://doi.org/10.1007/BF02123794

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02123794

Keywords

Search

Navigation