ABSTRACT
Clostridium difficile (C. difficile) is one of the important pathogens which cause antibiotic-associated diarrhea (AAD) -diarrhea following antibiotic therapy. There are some reports of nosocomial outbreak of AAD caused by C. difficile.We analyzed risk factors and epidemiology of C. difficile-associated diarrhea (CAD) in Kumiai Hospital. From March 2003 to February 2004, 53 in patients developed AAD, of whom 35 patients (66%) were diagnosed as having CAD. Advanced age, bed-rest, tube-feeding, and prolonged administration of antibiotics were regarded as risk factors.In initial two months, seven cases developed CAD in one ward and five in another ward. After hand-washing and use of gloves were enforced in treating CAD patients, the incidence of CAD decreased. Epidemiological analysis was performed using PCR ribotyping of C. difficile strains recovered from 20 among 35 CAD cases in the different wards. Nineteen of 20 strains were identical, typed as the ribotype. These results may suggest nosocomial diarrhea but we cannot conclude that is a hospital infection as yet.Although all C. difficile strains recovered in this study were toxin A-positive, the result of the test using a toxin A detecting kit was negative in three cases. It is necessary toculture C. difficile in addition to detecting toxin A to diagnose CAD.
