Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-15T06:15:33.616Z Has data issue: false hasContentIssue false
  • English
  • Français

Predominance of a Single Restriction Endonuclease Analysis Group with Intrahospital Subgroup Diversity Among Clostridium difficile Isolates at Two Chicago Hospitals

Published online by Cambridge University Press:  02 January 2015

Endale T. Mekonen ,
Dale N. Gerding ,
Susan P. Sambol ,
Jean M. Pottinger ,
Joseph J. Pulvirenti ,
Dayle Marsh ,
Frank E. Kocka  and
Stuart Johnson
Endale T. Mekonen
Affiliation:
Department of Medicine, Chicago Healthcare System, Division, andNorthwestern University Medical School, Chicago, Illinois
Dale N. Gerding
Affiliation:
Department of Medicine, Chicago Healthcare System, Division, andNorthwestern University Medical School, Chicago, Illinois
Susan P. Sambol
Affiliation:
Department of Medicine, Chicago Healthcare System, Division, andNorthwestern University Medical School, Chicago, Illinois
Jean M. Pottinger
Affiliation:
Department of Medicine, Chicago Healthcare System, Division, andNorthwestern University Medical School, Chicago, Illinois
Joseph J. Pulvirenti
Affiliation:
Division of Infectious Diseases, Cook County HospitalandRush Medical College, Chicago, Illinois
Dayle Marsh
Affiliation:
Division of Microbiology, Cook County HospitalandChicago Medical School, Chicago, Illinois
Frank E. Kocka
Affiliation:
Division of Microbiology, Cook County HospitalandChicago Medical School, Chicago, Illinois
Stuart Johnson*
Affiliation:
Department of Medicine, Chicago Healthcare System, Division, andNorthwestern University Medical School, Chicago, Illinois
*
Medicine Service, VA Chicago Healthcare System, Lakeside Division, 333 East Huron, Chicago, IL 60611
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine the epidemiology and relatedness of Clostridium difficile isolates in two geographically separated hospitals in a large metropolitan area, each with unique patients and personnel.

Design:

Observational descriptive molecular epidemiology of clinical C. difficile isolates.

Setting:

Two tertiary-care hospitals in Chicago.

Methods:

Consecutive C. difficile isolates from the clinical laboratory of a Veterans Affairs hospital during a 13-month period were typed by restriction endonuclease analysis (REA). During an overlapping 3-month period, stool specimens that tested positive for C. difficile toxin from patients at a nearby county hospital were cultured and the recovered isolates typed by the same method.

Results:

Nineteen (68%) of 28 nosocomial isolates at the smaller, Veterans Affairs hospital belonged to REA group K. Within this group of closely related strains, 9 distinct REA types were recognized. Twenty-one (72%) of 29 nosocomial isolates at the larger, county hospital also belonged to group K. However, the predominant REA types within group K differed markedly at each institution.

Conclusions:

These findings demonstrate a high degree of similarity among nosocomial C. difficile strains from different hospitals in the same city and suggest the possibility of an extended outbreak of a prototype group K strain with subsequent genetic drift at the two different institutions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 11 , November 2002 , pp. 648 - 652
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr.. Clostridium diffiale-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.CrossRefGoogle ScholarPubMed
2.Heard, SR, O'Farrell, S, Holland, D, Crook, S, Barnett, MJ, Tabaqchali, S. The epidemiology of Clostridium difficile with the use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients. J Infect Dis 1986;153:159–162.Google Scholar
3.Johnson, S, Clabots, CR, Linn, FV, Olson, MM, Peterson, LR, Gerding, DN. Nosocomial Clostridium difficile colonisation and disease. Lancet 1990;336:97–100.Google Scholar
4.Pear, SM, Williamson, TH, Bettin, KM, Gerding, DN, Galgiani, JN. Decrease in nosocomial Clostridium difficile-associated diarrhea by restricting clindamycin use. Ann Intern Med 1994;120:272–277.Google Scholar
5.Wust, J, Sullivan, NM, Hardegger, U, Wilkins, TD. Investigation of an outbreak of antibiotic-associated colitis by numerous typing methods. J Clin Microbiol 1982;16:1096–1101.Google Scholar
6.Clabots, CR, Peterson, LR, Gerding, DN. Characterization of a nosocomial Clostridium difficile outbreak by using plasmid profile typing and clindamycin susceptibility testing. J Infect Dis 1988;158:731–736.Google Scholar
7.Samore, MH, Bettin, KM, DeGirolami, PC, Clabots, CR, Gerding, DN, Karchmer, AW. Wide diversity of Clostridium difficile types at a tertiary referral hospital. J Infect Dis 1994;170:615–621.Google Scholar
8.Kristiansson, M, Samore, MH, Gerding, DN, et al. Comparison of restriction endonuclease analysis, ribotyping, and pulsed-field gel electrophoresis for molecular differentiation of Clostridium difficile strains. J Clin Microbiol 1994;32:1963–1969.CrossRefGoogle Scholar
9.Tang, YJ, Houston, ST, Gumerlock, PH, et al. Comparison of arbitrarily primed PCR with restriction endonuclease and immunoblot analyses for typing Clostridium difficile. J Clin Microbiol 1995;33:3169–3173.Google Scholar
10.Clabots, CR, Johnson, S, Bettin, KM, et al. Development of a rapid and efficient restriction analysis typing system for Clostridium difficile and correlation with other typing systems. J Clin Microbiol 1993;31:1870–1875.Google Scholar
11.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
12.Clabots, CR, Johnson, S, Olson, MM, Peterson, LR, Gerding, DN. Acquisition of Clostridium difficile by hospitalized patients: evidence for colonized new admissions as a source of infection. J Infect Dis 1992;166:561–567.Google Scholar
13.Samore, M, Killgore, G, Johnson, S, et al. Multicenter typing comparison of sporadic and outbreak Clostridium difficile isolates from geographically diverse hospitals. J Infect Dis 1997;176:1233–1238.CrossRefGoogle ScholarPubMed
14.Clabots, CR, Pearson, AC, Bettin, K, et al. Typing of Clostridium difficile (CD) strains responsible for epidemics in a hospital with a high endemic incidence of CD-associated diarrhea. In: American Society for Microbiology. Programs and Abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy (Chicago). Washington, DC: American Society for Microbiology; 1991:352. Abstract 1520.Google Scholar
15.Cartmill, TD, Panigrahi, H, Worsley, MA, McCann, DC, Nice, CN, Keith, E. Management and control of a large outbreak of diarrhoea due to Clostridium difficile. J Hosp Infect 1994;27:1–15.CrossRefGoogle ScholarPubMed
16.Nath, SK, Thornley, JH, Kelly, M, et al. A sustained outbreak of Clostridium difficile in a general hospital: persistence of a toxigenic clone in four units. Infect Control Hosp Epidemiol 1994;15:382–389.Google Scholar
17.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
18.Killgore, GE, Kato, H. Use of arbitrary PCR to type Clostridium difficile and comparison of results with those by immunoblot typing. J Clin Microbiol 1994;32:1591–1593.Google Scholar
19.Samore, MH, Venkataraman, L, DeGirolami, PC, Arbeit, RD, Karchmer, AW. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med 1996;100:32–40.Google Scholar
20.Sambol, SP, Tang, JK, Merrigan, MM, Johnson, S, Gerding, DN. Infection of hamsters with epidemiologically important strains of Clostridium difficile. J Infect Dis 2001;183:1760–1766.Google Scholar
21.Johnson, S, Samore, MH, Farrow, KAet al. Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med 1999;341:1645–1651.Google Scholar