High frequency of antibiotic-associated diarrhea due to toxin A-negative, toxin B-positive Clostridium difficile in a hospital in Japan and risk factors for infection

• Published in: European journal of clinical microbiology & infectious diseases 2003-09, Vol.22 (9), p.525-529
• Main Authors: KOMATSU, M, KATO, H, IWATANI, Y, AIHARA, M, SHIMAKAWA, K, IWASAKI, M, NAGASAKA, Y, FUKUDA, S, MATSUO, S, ARAKAWA, Y, WATANABE, M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Analysis of Variance; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteria; Bacterial Proteins; Bacterial Toxins - analysis; Biological and medical sciences; Body temperature; Child; Child, Preschool; Clostridium difficile - drug effects; Clostridium difficile - isolation & purification; Clostridium Infections - diagnosis; Clostridium Infections - epidemiology; Cohort Studies; Cross Infection - epidemiology; Cross Infection - microbiology; Diarrhea; Diarrhea - epidemiology; Diarrhea - etiology; Diarrhea - microbiology; Electrophoresis, Gel, Pulsed-Field; Enterotoxins - analysis; Female; Hospitals, Urban; Humans; Incidence; Infant; Japan - epidemiology; Male; Medical sciences; Middle Aged; Nosocomial infection; Pharmacology. Drug treatments; Probability; Regression analysis; Retrospective Studies; Risk Assessment; Risk factors; Statistics, Nonparametric; Toxins
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-003-0992-5

Patients hospitalized in a hospital with a high incidence of antibiotic-associated diarrhea due to toxin A-negative, toxin B-positive (A-/B+) Clostridium difficile were retrospectively investigated to determine the clinical manifestations and risk factors for infection. Of 77 Clostridium difficile isolates obtained from 77 patients during the 1-year investigation period, 30 were A-/B+ and 47 were toxin A-positive, toxin B-positive (A+/B+). By pulsed-field gel electrophoresis analysis, 23 of the 30 A-/B+ strains were outbreak-related, suggesting nosocomial spread of a single type of bacterium, which mainly affected patients in the wards of respiratory medicine, hematology and neurology. Using regression analysis, three factors were found to be associated with infection by A-/B+ isolates: (i) exposure to antineoplastic agents ( P=0.01, odds ratio [OR]=5.1), (ii) the use of nasal feeding tubes ( P=0.008, OR=5.2), and (iii) assignment to a certain internal medicine ward ( P=0.05, OR=3.0). Between patients with Clostridium difficile-associated diarrhea caused by A-/B+ strains and those with A+/B+ strains, no statistically significant difference was found in body temperature, serum concentration of C-reactive protein, leukocyte count in whole blood, frequency of diarrhea, or type of underlying disease. These results indicate that A-/B+ strains of Clostridium difficile can cause intestinal infection in humans and they spread nosocomially in the same manner as A+/B+ strains.