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Epidemiologic characteristics of Clostridium difficile infection in a tertiary hospital in Korea

Abstract number: 1734_160

Shin B-M., Yoo H.M., Kuak E-Y., Yoo S.J.

Introduction:Clostridium difficile is one of the most important pathogens responsible for nosocomial diarrhoea. The disease is mediated by two toxin, designated as A and B; therefore, identification of toxin is also important for diagnosis, treatment and infection control of C. difficile. The purpose of this study is to provide the basic features of the microbiological, clinical and endoscopic findings in a tertiary hospital in Korea for controlling C. difficile infection.

Methods: We evaluated 384 C. difficile positive cases that were cultured from Jan. 2004 to June 2005. We tested toxin A enzyme immunoassay using VIDAS CDA II. We amplified toxin A gene in culture positive cases to differentiate toxin A positive, variant and negative strains. Sigmoidoscopic/colonoscopic findings, departments of admission, underlying diseases and histories about antibiotic usages were evaluated.

Results: Of 384 culture positive cases, C. difficile were mainly isolated in medical and neuro-surgical parts. According to the age and gender, C. difficile were highly positive in elderly patients (>60 years; 67%) and no statistical difference was observed between male and female. Toxin A gene PCR assay revealed that the proportion of positive, variant and negative strains were 31%, 54% and 15%, respectively. Among culture positive cases, only 40% were underwent sigmoido/colonoscopy and 61% of them were diagnosed as pseudomembranous colitis (PMC)/colitis. Toxin A variant strains were highly associated with PMC instead of intact toxin A positive strains. No statistical differences were found in colitis between toxin A positive strains and variant strains. Among antibiotics, cepholosporin and aminoglycoside were the most frequently used agents. The highly associated underlying diseases were cerebrovascular diseases, malignancy, diabetes mellitus and cardiovascular diseases.

Conclusion: We shoud be aware of the C. difficile infection in elderly patients with underlying diseases (cerebrovascular diseases, malignancy, diabetes mellitus and cardiovascular diseases) and long-term usage of antimicrobial agents, especially cepholosporin and aminoglycoside. Toxin A variant strain was more important risk factor in PMC compared with toxin A positive strains.

Session Details

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