Molecular epidemiology of endemic Clostridium difficile infection in a general medicine ward: A two year study

Stuart H Cohen, D. Rahmani, Y. J. Tang, J. Muenzer, J. Silva

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Toxigenic Clostridium difficile is the leading cause of infectious diarrhea in hospital settings. The goal of this study was to investigate the epidemiology of endemic C. difficile associated diarrhea (CDAD) in our General Medicine ward with an incidence rate of 17.20 cases/1000 discharges over a two year period. Arbitrarily-primed polymerase chain reaction (AP-PCR) was used to determine strain identity of patient and environmental isolates of C. difficile endemic on the general medicine ward. The relatedness of these isolates and their persistence over time was investigated. AP-PCR genotyping grouped 57 of the 92 patient isolates analyzed to date into 30 types. One hundred ninety-six strains (88% toxigenic and 11% nontoxigenic) were recovered from environmental surfaces. AP-PCR analysis of 109 of these environmental isolates grouped them into 20 AP-PCR types. The predominant environmental type, a toxigenic strain (type 1), accounted for 64.2% of all environmental isolates. This endemic strain was present throughout the ward and persisted in the environment over the two year period of this study, This strain was also the predominant clinical isolate from the patients with CDAD (14/57, 24.6%). Though this strain was periodically found in most rooms in the ward, it persisted primarily in three rooms which also had a high incidence of CDAD cases. The persistence of this strain type in the environment and the high isolation rate from patients with CDAD strongly suggests that the environment may be a source of acquisition of C. difficile in our general medical ward.

Original languageEnglish (US)
Pages (from-to)475
Number of pages1
JournalClinical Infectious Diseases
Issue number2
StatePublished - 1997

ASJC Scopus subject areas

  • Immunology


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