This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (72)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

A French Multicenter Study

Frédéric Barbut, MD; Gérard Corthier, PhD; Yves Charpak, MD, PhD; Marc Cerf, MD, PhD; Henri Monteil, MD, PhD; Thierry Fosse, MD; André Trévoux, MD; Bertille De Barbeyrac, PhD; Yves Boussougant, MD; Sylvestre Tigaud, MD; Francis Tytgat, MD; Alain Sédallian, MD, PhD; Suzanne Duborgel, MD; Anne Collignon, MD, PhD; Marie-Emmanuelle Le Guern, MD; Paul Bernasconi, MD; Jean-Claude Petit, MD, PhD

Arch Intern Med. 1996;156(13):1449-1454.

Abstract
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%; ²=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

Footnotes
Affiliations of the authors are given in the acknowledgment section at the end of the article.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Epidemiology of Clostridium difficile Associated Diarrhea in a Peruvian Tertiary Care Hospital
Garcia et al.
Am J Trop Med Hyg 2007;77:802-805.
ABSTRACT | FULL TEXT  

In Vitro Susceptibility of Clostridium difficile Clinical Isolates from a Multi-Institutional Outbreak in Southern Quebec, Canada.
Bourgault et al.
Antimicrob. Agents Chemother. 2006;50:3473-3475.
ABSTRACT | FULL TEXT  

A Predominantly Clonal Multi-Institutional Outbreak of Clostridium difficile-Associated Diarrhea with High Morbidity and Mortality
Loo et al.
NEJM 2005;353:2442-2449.
ABSTRACT | FULL TEXT  

Use of a Selective Enrichment Broth To Recover Clostridium difficile from Stool Swabs Stored under Different Conditions
Arroyo et al.
J. Clin. Microbiol. 2005;43:5341-5343.
ABSTRACT | FULL TEXT  

Molecular Epidemiology of Endemic Clostridium difficile Infection and the Significance of Subtypes of the United Kingdom Epidemic Strain (PCR Ribotype 1)
Fawley et al.
J. Clin. Microbiol. 2005;43:2685-2696.
ABSTRACT | FULL TEXT  

An improved protocol for pulsed-field gel electrophoresis typing of Clostridium difficile
Alonso et al.
J Med Microbiol 2005;54:155-157.
ABSTRACT | FULL TEXT  

Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture
Delmee et al.
J Med Microbiol 2005;54:187-191.
ABSTRACT | FULL TEXT  

Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity
Pepin et al.
CMAJ 2004;171:466-472.
ABSTRACT | FULL TEXT  

Prevalent PCR ribotypes of clinical and environmental strains of Clostridium difficile isolated from intensive-therapy unit patients in Kuwait
Rotimi et al.
J Med Microbiol 2003;52:705-709.
ABSTRACT | FULL TEXT  

In Vitro Activity of Linezolid against Clostridium difficile
Pelaez et al.
Antimicrob. Agents Chemother. 2002;46:1617-1618.
ABSTRACT | FULL TEXT  

Infection Control in the ICU
Eggimann and Pittet
Chest 2001;120:2059-2093.
ABSTRACT | FULL TEXT  

PCR ribotyping of clinically important Clostridium difficile strains from Hungary
URBAN et al.
J Med Microbiol 2001;50:1082-1086.
ABSTRACT | FULL TEXT  

Comparison of PCR-Ribotyping, Arbitrarily Primed PCR, and Pulsed-Field Gel Electrophoresis for Typing Clostridium difficile
Bidet et al.
J. Clin. Microbiol. 2000;38:2484-2487.
ABSTRACT | FULL TEXT  

Epidemiology of Recurrences or Reinfections of Clostridium difficile-Associated Diarrhea
Barbut et al.
J. Clin. Microbiol. 2000;38:2386-2388.
ABSTRACT | FULL TEXT  

Predominant Staphylococcus aureus Isolated from Antibiotic-Associated Diarrhea Is Clinically Relevant and Produces Enterotoxin A and the Bicomponent Toxin LukE-LukD
Gravet et al.
J. Clin. Microbiol. 1999;37:4012-4019.
ABSTRACT | FULL TEXT  

Roles of Intracellular Calcium and NF-{kappa}B in the Clostridium difficile Toxin A-Induced Up-Regulation and Secretion of IL-8 from Human Monocytes
Jefferson et al.
J. Immunol. 1999;163:5183-5191.
ABSTRACT | FULL TEXT  

Antimicrobial Susceptibilities and Serogroups of Clinical Strains of Clostridium difficile Isolated in France in 1991 and 1997
Barbut et al.
Antimicrob. Agents Chemother. 1999;43:2607-2611.
ABSTRACT | FULL TEXT