Hostname: page-component-7479d7b7d-fwgfc Total loading time: 0 Render date: 2024-07-08T22:15:58.861Z Has data issue: false hasContentIssue false
  • English
  • Français

Clostridium difficile infection in patients with haematological malignant disease: Risk factors, faecal toxins and pathogenic strains

Published online by Cambridge University Press:  19 October 2009

S. R. Heard ,
B. Wren ,
M. J. Barnett ,
J. M. Thomas  and
S. Tabaqchali
S. R. Heard
Affiliation:
Department of Medical Microbiology, St Bartholomew's Hospital, LondonEC1
B. Wren
Affiliation:
Department of Medical Microbiology, St Bartholomew's Hospital, LondonEC1
M. J. Barnett
Affiliation:
Department of Medical Oncology, St Bartholomew's Hospital, LondonEC1
J. M. Thomas
Affiliation:
Department of Computer Studies, St Bartholomew's Hospital, LondonEC1
S. Tabaqchali
Affiliation:
Department of Medical Microbiology, St Bartholomew's Hospital, LondonEC1
Rights & Permissions [Opens in a new window]

Summary

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Two hundred and forty-eight patients from shared oncology and general medical wards were prospectively studied over a 6-month period for carriage of Clostridium difficile during an outbreak of clinical disease with an epidemic strain of the organism. Risk factors for infection were assessed. Acute leukaemia and/or its treatment were identified as significantly increasing the risk of infection.

The relationship between the type of C. difficile isolated (as defined by a typing system based on the incorporation of [35S]methionine into bacterial proteins followed by gel electrophoresis), the presence of faecal toxins A and B and clinical symptoms were analysed. Carriage of the epidemic strain, type X, had a significant association with symptoms amongst oncology patients, with two thirds of these patients having detectable faecal toxin A and one third detectable faecal toxin B. During an outbreak of C. difficile-associated disease, typing the organism and assaying for both faecal toxins in symptomatic patients may be of benefit in determining which patients require specific, urgent treatment.

Type
Research Article
Information
Epidemiology & Infection , Volume 100 , Issue 1 , February 1988 , pp. 63 - 72
Copyright
Copyright © Cambridge University Press 1988

References

REFERENCES

Barclay, F. & Borriello, S. P. (1981). Clostridium difficile and colonization resistance. In Antibiotic-associated-diarrhoea and Colitis (ed. Borriello, S. P.), pp. 80–87. The Hague: Martinus Nijhoff.Google Scholar
Bartlett, J. G. & Taylor, N. S. (1984). Antibiotic associated colitis. In Medical Microbiology, vol. I (ed. Easmon, C. S. F., Jelkjaszewicz, J., Brown, M. R. W. and Lambert, P. A.), pp. 1–48. London: Academic Press.Google Scholar
Burdon, D. W., George, R. H., Mogg, G. A. G., Aram, Y., Johnson, M., Alexander, Williams J. & Keighley, M. R. B. (1981). Faecal toxin and severity of antibiotic-associated pseudomembranous colitis. Journal of Clinical Pathology 32, 548–551.CrossRefGoogle Scholar
Delmee, M., Homel, M. & Wauters, G. (1985). Serogrouping of Clostridhnn difficile strains by slide agglutination. Journal of Clinical Microbiology 21, 323–327.CrossRefGoogle ScholarPubMed
Fainstein, V., Bodey, G. P. & Fekety, R. (1981). Relapsing pseudomembranous colitis associated with cancer chemotherapy. Journal of Infectious Diseases 143, 865.CrossRefGoogle ScholarPubMed
George, R. H., Symond, J. M., Dinnock, F., Brown, J. D., Arabi, Y., Shinagawa, N., Keighley, M., Alexander-Williams, J. & Burdon, J. D. W. (1978). Identification of Clostridium difficile as a cause of pseudomembranous colitis. British Medical Journal i, 695.CrossRefGoogle Scholar
George, W. L., Sutter, V. L., Citron, D. & Finegold, S. M. (1979). Selective and differential medium for isolation of Clostridium difficile. Journal of Clinical Microbiology 9, 214–219.CrossRefGoogle ScholarPubMed
Heard, S. R., O'Farrell, S., Holland, D., Crook, S., Barnett, M. J. & Tabaqchali, S. (1986). The epidemiology of Clostridium difficile with use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients. Journal of Infectious Diseases 1, 159–162.CrossRefGoogle Scholar
Holeman, L. V., Cato, E. P. & Moore, W. E. C. (eds) (1977). Anaerobe Laboratory Manual, 4th edn, p. 98. Virginia Polytechnic Institute and State University, Blacksburg, Virginia.Google Scholar
Keighley, B. R. B., Burdon, D. W., Aram, Y., Alexander-Williams, J., Thompson, H., Youngs, D., Johnson, M., Bentley, S. L., George, R. H. & Mogg, G. A. G. (1978). Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea. British Medical Journal ii, 1667–1669.CrossRefGoogle Scholar
Kim, K. H., Fekety, R., Batis, D. H., Brown, D., Cudmore, M., Silva, J. & Water, D. (1981). Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. Journal of Infectious Diseases 1, 42–50.CrossRefGoogle Scholar
Malamou-Ladas, H., O'Farrell, S., Nash, J. Q. & Tabaqchali, S. (1983). Isolation of Clostridium difficile from patients and the environment of hospital wards. Journal of Clinical Pathology 36, 88–92.CrossRefGoogle ScholarPubMed
Morris, J. G., Jarvis, W. R., Nuvey-Montiel, O. L., Towns, M. L., Thompson, P. S., Dowell, V. R., Hill, E. O., Vogler, W. R., Winton, E. F. & Hughes, J. M. (1984). Clostridmm difficile: colonization and toxin production in a cohort of patients with malignant haematological disorders. Archives of Internal Medicine 144, 967–969.CrossRefGoogle Scholar
Ramplino, A., Warren, R. E., Bevan, C. E., Hoggarth, C. E., Swirsky, D. & Hayhoe, F. G. J. (1985). Clostridium difficile in haematological malignancy. Journal of Clinical Pathology 38, 445–451.CrossRefGoogle Scholar
Redmond, S. C., Ketley, J. M., Mitchell, T. J., Stephens, J., Burdon, D. W. & Candy, D. C. A. (1985). Detection of Clostridium difficile enterotoxin (toxin A) by ELJSA and other techniques. In Isolation and Identification of Microorganisms of Medical and Veterinary Importance (ed. Collins, C. H. and Grange, J. M.), Society for Applied Bacteriology Technical Series 21, pp. 237–249. London: Academic Press.Google Scholar
Rogers, T. R., Petkou, M., Lucas, C., Chung, J. T. N. & Barrett, A. J. (1981). Spread of Clostridium difficile among patients receiving non-absorbable antibiotics for gut decontamination. British Medical Journal 283, 408–409.CrossRefGoogle ScholarPubMed
Slavin, R. E., Dias, M. B. & Soral, R. (1978). Cytosine arabinoside induced gastrointestinal toxic alterations in sequential chemotherapeutic protocols. A clinicopathologic study of 33 patients. Cancer 42, 1747–1759.3.0.CO;2-T>CrossRefGoogle Scholar
Stephens, J., Wilkins, T., Krivan, H., Stiles, B., Carmen, R. & Lyerly, D. (1985). Clostridial toxins active locally in the gastrointestinal tract. In Microbial Toxins and Diarrhoeal Disease (Ciba Foundation Symposium), pp. 230–241. London: Pitman.Google Scholar
Tabaqchali, S., O'Farrell, S., Holland, D. & Silman, R. (1984). Typing scheme for Clostridium difficile: its application in clinical and epidemiological studies. Lancet i, 935–938.CrossRefGoogle Scholar
Tabaqchali, S., O'Farrell, S., Holland, D. & Silman, R. (1986). Method for typing of Clostridium difficile based on PAGE of 35S-Methionine-labelled proteins. Journal of Clinical Microbiology 23, 197–198.CrossRefGoogle Scholar
Tedesco, F. J. (1982). Pseudomembranous colitis: pathogenesis and therapy. Medical Clinics of North America 3, 655–664.CrossRefGoogle Scholar
Thompson, G. M., Gilligan, P. H. & Long, S. S. (1982). Interrelationships of stool flora and Clostridium difficile in children with cystic fibrosis. Proceedings of the 22nd International Conference on Antimicrobial Agents and Chemotherapy. Abstract 594.Google Scholar
Viscidi, R., Willey, S. & Bartlett, J. G. (1981). Isolation rates and toxigenic potential of Clostridium difficile isolates from various patient populations. Gastroenterology 81, 5–9.CrossRefGoogle ScholarPubMed
Wilson, K. H. & Sheagren, J. N. (1983). Antagonism of toxigenic Clostridium difficile by nontoxigenic C. difficile. Journal of Infectious Diseases 4, 733–735.CrossRefGoogle Scholar