Clostridium difficile cytotoxin B in adults with diarrhea: a comparison of patients treated or not treated with antibiotics prior to infection

• Published in: CLINICAL MICROBIOLOGY AND INFECTION Vol. 7; no. 8; pp. 447 - 450
• Main Authors: Svenungsson, B., Lagergren, Å., Lundberg, A.
• Format: Journal Article Publication
• Language: English
• Published: Oxford, UK Elsevier Ltd 01.08.2001; Blackwell Science Ltd; Blackwell; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - adverse effects; Anti-Bacterial Agents - therapeutic use; Antibiotics; antimicrobial susceptibility; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Bacterial Proteins; Bacterial Toxins - analysis; Biological and medical sciences; Clostridium difficile; Clostridium difficile - growth & development; Clostridium difficile - metabolism; Diarrhea - microbiology; Drug Resistance, Microbial; enteritis; Enterocolitis, Pseudomembranous - microbiology; Feces - chemistry; Feces - microbiology; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Microbial Sensitivity Tests; Middle Aged; Prospective Studies; Statistics, Nonparametric; enteritis; antimicrobial susceptibility; Clostridium difficile; Human; Drug susceptibility test; Pathogenesis; Clostridiales; Diarrhea; Infection; Toxin; Antibiotic; Treatment; Clostridiaceae; Minimum inhibitory concentration; Risk factor; Bacteriosis; Digestive diseases; Bacteria; Intestinal disease; Adult; Feces; Antibacterial agent
• ISSN: 1198-743X; 1469-0691
• DOI: 10.1046/j.1469-0691.2001.00314.x

Departments of Medicine and Immunology Microbiology, Pathology and Infectious Diseases, Karolinska Institute, Huddinge University Hospital, Huddinge, Sweden To study the detection rate of Clostridium difficile cytotoxin B in stool specimens from adults with diarrhea as related to previous antimicrobial treatment. Stool specimens from 802 adult patients with diarrhea and 203 healthy controls were tested for C. dificile cytotoxin B using a cell cytotoxicity assay. Antibiotic susceptibility testing of C. difficile was performed with the E test. Of 173 patients treated with antimicrobial medication within 5 weeks of onset of diarrhea, 60 (35%) were positive for C. difficile cytotoxin B (group A) compared to only 41 (7%) of 629 untreated patients (group B) and two of the 203 (1%) healthy controls. Compared to patients in group A, patients in group B possessed characteristics not usually connected with C. difficile disease. They were generally younger (median age 40 years vs. 73 years), had been hospitalized less frequently (10% vs. 67%), had more often travelled abroad within the previous 2 weeks (46% vs. 1%), and more often had multiple enteropathogens (41% vs. 3%). Minimal inhibitory concentrations for vancomycin, metronidazole and fucidic acid to C. difficile isolates ranged from 0.5 to 4 mg/L, from 0.125 to 256 mg/L and 0.25 to 4 mg/L, respectively. The detection rate of C. difficile cytotoxin B in patients with diarrhea, not associated with antibiotic treatment, is comparable to that in healthy control subjects. It probably merely reflects a carrier state without clinical significance.