Clostridium difficile prevalence rates in a large healthcare system stratified according to patient population, age, gender, and specimen consistency

• Published in: European journal of clinical microbiology & infectious diseases Vol. 31; no. 7; pp. 1551 - 1559
• Main Authors: Boone, J. H., Goodykoontz, M., Rhodes, S. J., Price, K., Smith, J., Gearhart, K. N., Carman, R. J., Kerkering, T. M., Wilkins, T. D., Lyerly, D. M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.07.2012; Springer; Springer Nature B.V
• Subjects: Adolescent; Adult; Age; Age Factors; Aged; Aged, 80 and over; Ambulatory care; Antibiotics; Asymptomatic; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Child; Clostridium difficile - classification; Clostridium difficile - drug effects; Clostridium difficile - genetics; Clostridium difficile - isolation & purification; Clostridium Infections - epidemiology; Clostridium Infections - microbiology; Cross Infection - epidemiology; Cross Infection - microbiology; Drug Resistance, Bacterial; Feces - microbiology; Female; Fluoroquinolones - pharmacology; Gastroenterology. Liver. Pancreas. Abdomen; Gender; Health Facilities; Human bacterial diseases; Humans; Indexing in process; Infectious diseases; Inflammatory bowel disease; Internal Medicine; Male; Medical laboratories; Medical Microbiology; Medical sciences; Middle Aged; Nursing homes; Other diseases. Semiology; Patient assessment; Prevalence; Ribotyping; Risk Factors; Sex Factors; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Toxins; Young Adult; United States > US; Virginia; Nursing Home Patient; Moxifloxacin; Fluoroquinolone Resistance; Inflammatory Bowel Disease Patient; Stool Specimen; Human; Prevalence; Microbiology; Clostridium difficile; Sex; Clostridiales; Diarrhea; Epidemiology; Infection; Clostridiaceae; Bacteria; Digestive diseases; Intestinal disease; Age
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-011-1477-6

We evaluated Clostridium difficile prevalence rates in 2,807 clinically indicated stool specimens stratified by inpatient (IP), nursing home patient (NH), outpatient (OP), age, gender, and specimen consistency using bacterial culture, toxin detection, and polymerase chain reaction (PCR) ribotyping. Rates were determined based on the detection of toxigenic C. difficile isolates. We identified significant differences in the rates between patient populations and with age. Specimens from NH had a higher rate (46%) for toxigenic C. difficile than specimens from IP (18%) and OP (17%). There were no gender-related differences in the rates. Liquid specimens had a lower rate (15%) than partially formed and soft specimens (25%) and formed specimens (18%) for the isolation of toxigenic C. difficile . The nontoxigenic rate was lowest for NH (4%) and highest for patients <20 years of age (23%). We identified 31 different toxigenic ribotypes from a sampling of 190 isolates that showed the lowest diversity in NH. Fluoroquinolone resistance was observed in 93% of the 027 isolates, all of the 053 isolates, and in four other ribotypes. We observed different rates for toxigenic C. difficile in stratified patient populations, with the highest rate for NH, a low overall nontoxigenic rate, and fluoroquinolone resistance.