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01 July 1999

Clostridium difficile as aetiological factor of diarrhoea in hospitalised patients on antibiotic therapy

Eugenia Gospodarek, Agnieszka Mikucka, Ewa Sieradzka

Med Sci Monit 1999; 5(4): BR647-651 :: ID: 503465

Abstract

The infection with Clostridium difficile is one of the most important causes of diarrhoea in patients after antibiotic therapy. Toxins produced by these bacteria damage enterocytes which leads to acute colitis, while the infection requires specific treatment. Microbiological analysis of the presence of C. difficile was performed on 62 faecal samples obtained from patients with the diagnosis of PMC, AAD. The culture was established on the basis of the faeces as well as faecal samples treated with ethyl alcohol. The media with cultures were incubated at 37¡C in anaerobic conditions, using Generbox system (bio-Merieux). Simultaneously, a culture in aerobic conditions was conducted. All faecal samples and isolated C. difficile strains were investigated with respect to toxigenicity with the use of CULTURETTE BRAND Toxin CD Test (Becton Dickinson) or C. difficile Toxin A Test (Oxoid). On the whole, 23 (37.10%) C. difficile strains were cultured, out of which 11 (47.83%) produced toxin A. The majority of analysed material was obtained from patients with clinical diagnosis of AAD (83.87%). In this group 19, (36.54%) C. difficile strains were isolated; 9 (47.37%) of them were toxigenic. Toxin A test performed directly in the faeces revealed the presence of toxin A in 3 (4.84%) samples obtained from patients with AAD. Among faecal samples with negative result of a test for the presence of C. difficile, multiresistant strains of Gram-negative bacilli were isolated in 6 cases, including the strains resistant to the antibiotics used in the treatment of these patients. Enterococcus spp. resistant to antibiotics were isolated from 5 faecal samples. Two Enterococcus sp. strains resistant to antibiotics were isolated from the samples of the faeces, in which C. difficile was cultured. All the Enterococcus sp. strains were sensitive to glycopeptides. The use of ethyl alcohol in the treatment of faecal samples in C. difficile diagnostics enables to obtain this bacteria in a monoculture which speeds up the result of the investigation by 1Ð2 days. It is advisable to include tests for the presence of C. difficile in the diagnostics of diarrhoea related to previously used antibiotic therapy, and to pay special attention to the presence and antibiotic-sensitivity of other micro-organisms.

Keywords: C. difficile, pseudomembranous colitis, antibiotic associated diarrhoea

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