A prospective clinical and molecular epidemiologic study was conducted to define the frequency of nosocomial Clostridium difficile patient-to-patient transmission in an urban tertiary referral hospital.
Over a 6-month period, environmental cultures for C difficile were obtained from patients with new positive stool cytotoxin assay (index cases) ; stool samples were obtained from selected patient contacts (the roommate, occupants of adjacent rooms, and the patient occupying the index room after discharge of the index case) ; and hand cultures were obtained from personnel contacts.
C difficile isolates were analyzed by pulse-field gel electrophoresis (PFGE) or, for isolates that were nontypeable by PFGE, by restriction enzyme analysis.
During the study period, we identified 98 index cases of C difficile toxin-associated diarrhea, including focal outbreaks on two wards totaling 26 cases within a 2-month interval.
Environmental contamination was detected at kappa1 sites in 58% of rooms and often involved wide dispersed areas.
Among 99 prospectively identified patient contacts, C difficile was cultured from the stool of 31 (31%), including 12 with diarrhea and 19 who were asymptomatic.
C difficile was cultured from the hands of 10 (14%) of 73 personnel.
Molecular analysis resolved 31 typing profiles among the index isolates ; the most common profile (designated strain Dl) was represented by 30 isolates.
Among the isola...
Mots-clés Pascal : Diarrhée, Bactériose, Infection, Clostridium difficile, Clostridiaceae, Clostridiales, Bactérie, Exploration bactériologique, Biologie moléculaire, Infection nosocomiale, Transmission homme homme, Epidémiologie, Diagnostic, Homme, Etats Unis, Amérique du Nord, Amérique, Appareil digestif pathologie, Intestin pathologie, Santé publique
Mots-clés Pascal anglais : Diarrhea, Bacteriosis, Infection, Clostridium difficile, Clostridiaceae, Clostridiales, Bacteria, Bacteriological investigation, Molecular biology, Nosocomial infection, Transmission from man to man, Epidemiology, Diagnosis, Human, United States, North America, America, Digestive diseases, Intestinal disease
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0142989
Code Inist : 002B05B02F. Création : 199608.