EPIDEMIOLOGIC-STUDY OF 22 DIARRHEAS DUE T O CLOSTRIDIUM-DIFFICILE IN A GERIATRIC HOSPITAL - EVALUATION OF 3 MARKERS

In a geriatric hospital of Saint-Etienne (Charite), among 153 patients having presented a nosocomial diarrhea from September 1990 to August 1991 Clostridium difficile (C.d.) has been isolated in 22 cases. Two o f the nine units of the hospital had the highest incidence rates : 4.6 and 3.7 %. In the faeces of 16 patients, C.d. was toxinogenic. In all cases, except one, antibiotic preceded diarrhea. Amoxillin + clavulan ic acid treatment was the most frequently responsible (65 %). For dete cting an eventual outbreak, several epidemiologic markers were evaluat ed : Clindamycin MIC, protein profiles, serotyping. Clindamycin suscep tibility differentiated two Cd. types. but has no epidemiologic value. Protein profiles, performed by SDS-Page, individualized 6 different p rofiles, but 10 strains gave no classifiable profiles. files. Serotypi ng, applied by M. Delmee, appeared as the most interesting marker. Inq uiry allowed to eliminate an outbreak but revealed two episodes of cro ss contaminations in the 3 units, 2 of them having the highest inciden ce rates. Markers proved persistence of the same C.d. strain in some p atients who were correctly treated by metronidazole.