[A rapid test for detecting Clostridium difficile]. / Schnelltest zum Nachweis von Clostridium difficile.

Staphylococcus aureus cells, strain Cowan 1, were coated with an anti-Clostridium difficile serum, produced in rabbits. This reagents were used in the coagglutination (coa-test) for detection of Clostridium difficile. A total of 275 bacterial cultures of different species were tested for detection of Clostridium difficile by coa-test and bacterial culture. Of 183 strains positive by isolation of the organism, 181 were positive by coa-test. The sensitivity and specificity of the coa-test relative to bacterial culture was 98.9% and 90.2%. A total of 206 stool specimens of children were tested also for detection of Clostridium difficile with both methods. From 16 specimens which were positive in bacterial culture 12 were positive in coa-test. The total number of samples which were positive with the coa-test was 46. The sensitivity and specificity of the coa-test in stool specimens relative to the isolation of the organism were 75.0% and 75.8%, respectively. The high predictive value for a negative result of the coa-test relative to the culture from 97.6% (bacterial cultures) and 97.3% (stool specimens) suggest that the coa-test will be a useful, rapid and simple screening test for Clostridium difficile. Specimens positive by the coa-test must be confirmed by the bacterial culture. Of some other Clostridium spp. tested, strains of Clostridium bifermentans and Clostridium sordelli also gave a positive result.

Demonstration of capsules in Clostridium difficile.

In four strains of Clostridium difficile the formation of capsules was demonstrated by light and electron microscopy.

Occurrence and significance of Clostridium difficile in faecal specimens of hospitalized children.

Stool specimens from 766 hospitalized children, 418 with diarrhoea and 348 controls, were investigated for C. difficile. In both groups the rate of isolation was highest (about 30%) during the first year of life, dropping to nearly 5% in older children. There was no significant difference in the frequency of C. difficile in children with diarrhoea and the controls nor was there a significant influence of previous antibiotic therapy on the rate of isolation. 111/135 strains (82.2%) produced toxin B and 58/135 strains (43%) produced toxin A measured by Y-1- cell culture (toxin B) and rabbit ileal loop test (toxin A). We did not find any significant difference in the toxin production between strains isolated from diarrhoeal children and from the controls. A total of 285 stool specimens was investigated for toxin B production in vivo. There was no significant difference of toxin B in the stool specimens of both groups.