Prevalence and Pathogenicity of Clostridium... : Archives of Internal Medicine (original) (raw)

Prevalence and Pathogenicity of Clostridium difficile in Hospitalized Patients

A French Multicenter Study

Frederic Barbut
Gerard Corthier
Yves Charpak
Marc Cerf
Henri Monteil
Thierry Fosse
Andre Trevoux
Bertille De Barbeyrac
Yves Boussougant
Sylvestre Tigaud
Francis Tytgat
Alain Sedallian
Suzanne Duborgel
Anne Collignon
Marie-Emmanuelle Le Guern
Paul Bernasconi
Jean-Claude Petit

Background

Although Clostridium difficile is the main agent responsible for nosocomial diarrhea in adults, its prevalence in stool cultures sent to hospital microbiology laboratories is not clearly established.

Objectives

To determine the prevalence of C difficile in inpatient stools sent to hospital microbiology laboratories and to assess the relationship between serotypes and toxigenicity of the strains isolated and the clinical data.

Methods

From January 18, 1993, to July 31, 1993, the presence of C difficile was systematically investigated in a case-control study on 3921 stool samples sent for stool culture to 11 French hospital microbiology laboratories. The prevalence of C difficile in this population (cases) was compared with that of a group of 229 random hospital controls matched for age, department, and length of stay (controls). Stool culture from controls was requested by the laboratory although not prescribed by the clinical staff. Serotype and toxigenesis of the strains isolated were compared.

Results

The overall prevalence of C difficile in the cases was twice the prevalence in the controls (9.7% vs 4.8%; P<.001) and was approximately 4 times as high in diarrheal stools (ie, soft or liquid) as in normally formed stools from controls (11.5% vs 3.3%; P<.001). The strains isolated from diarrheal stools were more frequently toxigenic than those isolated from normally formed stools. Serogroup D was never toxigenic, and its proportion was statistically greater in the controls than in the cases (45% vs 18%; chi squared=5.2; P<.05). Conversely, serogroup C was isolated only from the cases. Clostridium difficile was mainly found in older patients (>65 years), suffering from a severe disabling disease, who had been treated with antibiotics and hospitalized for more than 1 week in long-stay wards or in intensive care.

Conclusions

This multicenter period prevalence study clearly supports the hypothesis of a common role of C difficile in infectious diarrhea in hospitalized patients. Disease associated with C difficile should therefore be systematically evaluated in diarrheal stools from inpatients.

Arch Intern Med. 1996;156:1449-1454