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Prospective study of Clostridium difficile colonization and para-cresol detection in the stools of babies on a special care unit

Published online by Cambridge University Press:  19 October 2009

T. J. Phua ,
T. R. Rogers  and
A. P. Pallett
T. J. Phua
Affiliation:
Department of Medical Microbiology, Westminster Medical School, Horseferry Road, London SWAP 2AR, U.K.
T. R. Rogers*
Affiliation:
Department of Medical Microbiology, Westminster Medical School, Horseferry Road, London SWAP 2AR, U.K.
A. P. Pallett
Affiliation:
Department of Medical Microbiology, Westminster Medical School, Horseferry Road, London SWAP 2AR, U.K.
*
*For correspondence
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Infants' stools were examined for the presence of Clostridium difficile and its cytotoxin in a study performed over a one-year period on a special care baby unit. Overall, 21% of infants were colonized, but the organism was only recovered in a seven-month period during which its weekly prevalence in the group varied from zero to 44%, with a distinct clustering of colonized infants being observed. Tests for the presence of cytotoxin in the stools and in supernatants of broth that had been inoculated with each isolate were negative. The factors predisposing to colonization were a prolonged stay in the unit, low birth weight, younger gestational age and being nursed in an incubator. The organism was recovered only once from an environmental screen.

An antibiogram, used in conjunction with toxin production, was helpful in distinguishing these isolates from a collection obtained from other units in the hospital. We conclude that Cl. difficile was acquired by nosocomial spread although we did not establish the precise mechanism involved.

The detection of para-cresol by gas–liquid chromatography was found to be specific but insufficiently sensitive as a screening test for the organism's presence in the stools. It could only be demonstrated in infants whose birth-weights were less than 2500 g, and no association was observed between the type of feed and para-cresol presence in stools.

Type
Research Article
Information
Journal of Hygiene , Volume 93 , Issue 1 , August 1984 , pp. 17 - 25
Copyright
Copyright © Cambridge University Press 1984

References

REFERENCES

Bone, E., Tamm, A. & Hill, M. (1976). The production of urinary phenols by gut bncteriu and their possible role in the causation of large bowel cancer. The American Journal of Clinical Nutrition 29, 1448–1454.CrossRefGoogle ScholarPubMed
Cashore, W. J., Peter, G., Lauermann, M., Stonestreet, B. S. & Oh, W. (1981). Clostridia colonization and clostridial toxin in neonatal necrotizing enterocolitis. Journal of Pediatrics 98, 308–311.CrossRefGoogle ScholarPubMed
Cooperstock, M., Riegle, L., Woodruff, C. W. & Onderdonk, A. (1983). Influence of age, sex and diet on asymptomatic colonization of infants with Clostridium difficile. Journal of Clinical Microbiology 17, 830–833.CrossRefGoogle ScholarPubMed
Elsden, S. R., Hilton, M. G. & Waller, J. M. (1976). The end products of the metabolism of aromatic amino acids by clostridia. Archives of Microbiology 107, 283–288.CrossRefGoogle Scholar
Gorbach, S. L., Menda, K. B., Thadepalli, H. & Keith, L. (1973). Anaerobic microflora of the cervix in healthy women. American Journal of Obstetrics and Gynecology 117, 1053–1055.CrossRefGoogle ScholarPubMed
Greenfield, C., Aguilar Ramirez, J. R., Pounder, R. E., Williams, T., Danvers, M., Marper, S. R. & Noone, P. (1983). Clostridium difficile and inflammatory bowel disease. Gut 24, 713–717.CrossRefGoogle ScholarPubMed
Hall, I. C. & O'Toole, E. (1935). Intestinal flora in new-born infants, with a description of a new anaerobe, Bacillus difficilis. American Journal of Diseases of Children 49, 390–402.CrossRefGoogle Scholar
Hafiz, S. & Oakley, C. L. (1976). Clostridium difficile – isolation and characteristics. Journal of Medical Microbiology 9, 129–136.CrossRefGoogle ScholarPubMed
Holdeman, L. V., Cato, E. P. & Moore, W. E. C. (1977). Anaerobe Laboratory Manual,(4th ed.) p. 147. Blackburg, VA 24061: Virginia Polytechnic Institute and State University.Google Scholar
Larson, H. E., Barclay, F. E., Honour, P. & Hill, I. D. (1983). Epidemiology of Clostridium difficile in infants. Journal of Infectious Diseases 146, 727–733.CrossRefGoogle Scholar
Larson, H. E., Price, A. B., Honour, P. & Borriello, S. P. (1978). Clostridium difficile and the aetiology of pseudomembranous colitis. Lancet i, 1063–1066.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
Phillips, K. D. & Rogers, P. A. (1981). Rapid detection and presumptive identification of Clostridium difficile by p-cresol production on a selective medium. Journal of Clinical Pathology 34, 642–644.CrossRefGoogle ScholarPubMed
Potvliege, C., Labbé, M. & Yourassowsky, E. (1981). GLC as screening test for Clostridium difficile. Lancet ii, 1105.CrossRefGoogle Scholar
Rogers, T. R., Petrou, M., Lucas, C., Chung, J. T. N., Barrett, A. J., Borriello, S. P. & Honour, P. (1981). Spread of Clostridium difficile among patients receiving non-absorbable antibiotics for gut decontamination. British Medical Journal 283, 408–409.CrossRefGoogle ScholarPubMed
Sell, T. L., Schaberg, D. R. & Fekety, F. R. (1983). Bacteriophage and bacteriocin typing scheme for Clostridium difficile. Journal of Clinical Microbiology 17, 1148–1152.CrossRefGoogle ScholarPubMed
Sherertz, R. J. & Sarubbi, F. A. (1982). The prevalence of Clostridium difficile and toxin in a nursery population – a comparison between patients with necrotizing enterocolitis and an asymptomatic group. Journal of Pediatrics 100, 435–439.CrossRefGoogle Scholar
Stark, P. L. & Lee, A. (1982). Clostridia isolated from the feces of infants during the first year of life. Journal of Pediatrics 100, 362–365.CrossRefGoogle ScholarPubMed
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
Wysowski, D. K., Flynt, J. W., Goldfield, M., Altman, R. & Davies, A. T. (1978). Epidemic neonatal hyperbilirubinaemia and use of a phenolic disinfectant detergent. Pediatrics 61, 165–170.CrossRefGoogle ScholarPubMed
Yokoyama, M. T., Tabori, C., Miller, E. R. & Hogberg, M. G. (1982). The effects of antibiotics in the weanling pig diet on growth and the excretion of volatile phenolic and aromatic bacterial metabolites. The American Journal of Clinical Nutrition 35, 1417–1424.CrossRefGoogle ScholarPubMed