Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea

Abstract

Antibiotic-associated diarrhoea (AAD) represents a clinical entity leading to prolonged hospital stays and diagnostic and therapeutic procedures, and results in additional costs. The aim of the present study was to assess the prevalence and characteristics of different bacteria in stools of patients with AAD. The reliability of diagnostic procedures under routine conditions was evaluated. Host factors were also analysed. From June 2002 to April 2003 89 cases of diarrhoea were reported at a hospital unit for internal medicine. Clostridium difficile and Clostridium perfringens toxin enzyme-immunoassays (EIAs), and culture for C. difficile, C. perfringens and Staphylococcus aureus were performed on stool samples from all patients. Toxin production was determined in isolated S. aureus strains. In vitro susceptibility of S. aureus for oxacillin and of C. difficile for vancomycin, metronidazole, linezolid, fusidic acid and tetracycline was tested. Host factors, such as age, comorbidities, antibiotic exposure and contact with other patients, were evaluated. Twenty-six stools were positive for C. difficile toxins by an EIA technique, while C. difficile was cultured from 39. C. difficile was isolated from 21 stools that were EIA negative. Additionally, from 28 stools S. aureus and/or C. perfringens could be isolated. Nine samples contained only S. aureus and/or C. perfringens. Thirty-one stools were negative in all tests. All C. difficile isolates were susceptible to vancomycin and metronidazole. Age .60 years, and diseases of the vascular system, the heart, the kidneys and the lungs were identified as risk factors for acquiring C. difficile in this setting (P values , 0 . 05). Stool culture for C. difficile was shown to be more sensitive than toxin EIA in this study. Risk factors for the acquisition of C. difficile in outbreak situations seem to differ from risk factors in the normal hospital setting. The role of toxin-producing S. aureus in cases of AAD needs further investigation.

Intestinal carriage of Staphylococcus aureus: how does its frequency compare with that of nasal carriage and what is its clinical impact?

“…In this study S. aureus was the only identified pathogenic micro-organism to cause AAD in 47 patients and the presence of staphylococcal enterotoxin A was strongly associated with the development of diarrhea. A German study reported intestinal carriage of S. aureus, in the absence of C. difficile in 8% of patients with AAD [69]. Compelling evidence for the etiological role of MRSA in AAD was provided by excluding the involvement of C. difficile, numerous other bacterial pathogens and parasites, but also several enteric viruses in 11 patients with enterotoxin-producing MRSA intestinal carriage [70].…”

The Mosaic Nature of Intergenic 16S-23S rRNA Spacer Regions Suggests rRNA Operon Copy Number Variation in Clostridium difficile Strains

“…In the diagnosis and typing of C. difficile, culture techniques are seldom used, which may result in underestimating the detection of this organism (19). Instead, several immunological (2,8,65,66) and PCR-based methods, including those directed at identifying and in some cases quantifying the tcdA and tcdB genes and the cdtA and cdtB genes, encoding TcdA and TcdB or CDT, respectively, in stool samples, have been described (6,22,38,52).…”

Monocyte Chemoattractant Protein-1 Production by Intestinal Myofibroblasts in Response to Staphylococcal Enterotoxin A: Relevance to Staphylococcal Enterotoxigenic Disease

“…This form of food poisoning is severe: 10% of the affected individuals require a visit or an admission to the hospital (1)(2)(3)(4)(5)(6). Staphylococcal enterotoxin food poisoning leads to inflammatory changes throughout the gastrointestinal (GI) tract with severe lesions in the jejunum and ileum (7)(8)(9)(10).…”