Study on Clostridiumdifficile-associated diarrhoea in a hospital in Japan

Abstract number: 1733_1420

Ito Y., Matsushita T., Takahashi Y., Nakamura T., Hayashi K., Morita E., Kato H.

Objectives: In Europe and North America, several outbreaks due to NAP1/027 Clostridiumdifficile have been reported. In our hospital the number of patients with C. difficile-associated diarrhoea (CDAD) increased after January 2005. Our aim of this study is to know nosocomial transmission of specific strains including NAP1/027 among these patients.

Methods: Subjects were 15 patients who suffered from CDAD between January 2005 and March 2006 in Gifu Red Cross hospital, general hospital of 310 beds. The occurrence of CDAD did not concentrate on a single ward, and extended to 5 wards. Five patients had recurrent episodes of CDAD. CDAD was defined as diarrhoea associated with positive for toxigenic culture and/or toxin A assay. The toxin-producing type of isolates was determined by PCR and PCR ribotyping of isolates was performed.

Results: Twenty-two strains of C. difficile were isolated from 22 episodes. Twenty strains of C. difficile were toxin-A positive, toxin-B positive and 2 strains were toxin-A negative, toxin-B positive. PCR detecting the binary toxin gene was positive in 3 isolates from 2 patients. Twenty-two isolates were typed into 9 different PCR ribotypes. Type smz, which has been recognized as an epidemic type causing outbreaks in multiple hospitals in Japan, was recovered from 7 episodes of 4 patients and dominant in our hospital. Other three types were isolated from 2 or 3 patients each. Of 5 patients with recurrent CDAD, 4 patients relapsed with the original strain and 1 patient acquired a new strain. PCR ribotype gc8 (Brazier's PCR ribotype 027) was isolated from one patient with pseudomembranous colitis, who had recurrent diarrhoea caused by the same type. This type was recovered from no other patients.

Conclusions: Not a wide spread of a single C. difficile strain but a small scale transmission of several C. difficile strains was found to be related to the occurrence of CDAD. Although nosocomial spread of NAP1/027 strain was not recognized in our hospital, the isolation of the strain in Japan indicates the potential for wide spread of the strain in Japanese hospitals.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
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