ISOLATION OF VARIOUS GENOTYPES OF CLOSTRIDIUM-DIFFICILE FROM PATIENTSAND THE ENVIRONMENT IN AN ONCOLOGY WARD

The epidemiology of Clostridium difficile-associated diarrhea (CDAD) i s not well defined in nonepidemic situations because precise biotyping techniques have only recently become available. Arbitrarily primed po lymerase chain reaction (AP-PCR) was used to determine strain identity of C. difficile isolates recovered on our oncology ward, at an incide nce rate of 0.84%. Twenty-one strains of C. difficile, which were grou ped into 18 different AP-PCR types, were isolated from patients' speci mens. Forty-two C. difficile isolates recovered from the environment ( 33 toxigenic and 9 nontoxigenic) represented 9 different AP-PCR types. The most commonly found type, a toxigenic strain accounting for 29% o f the environmental isolates, was widespread throughout the ward. None of the environmental types were found among the isolates from patient s, Three patients' isolates were of the same AP-PCR type, and two of t hese patients had occupied neighboring rooms at the same time. The div ersity of C. difficile isotypes suggests that endemic nosocomial CDAD is not necessarily clonally spread.