Assuntos
Antibacterianos/farmacologia , Compostos Aza/farmacologia , Clostridioides difficile/efeitos dos fármacos , Farmacorresistência Bacteriana , Fezes/química , Fluoroquinolonas/farmacologia , Lactoferrina/metabolismo , Quinolinas/farmacologia , Clostridioides difficile/genética , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/microbiologia , Infecções por Clostridium/fisiopatologia , Fezes/microbiologia , Humanos , Inflamação/fisiopatologia , Intestinos/imunologia , Intestinos/microbiologia , Intestinos/fisiopatologia , Lactoferrina/análise , Testes de Sensibilidade Microbiana , MoxifloxacinaRESUMO
INTRODUCTION: The binary toxin genes cdt and cdtB have been detected in approximately 5% of Clostridium difficile strains. Severe C. difficile disease (CDD) may be associated with strains that carry the binary toxin genes. METHODS: From April 2001 through March 2002, 8 severe and 41 nonsevere cases of nosocomial CDD were studied. Severe cases of CDD were defined by the presence of >or=2 of the following criteria: (1) abdominal pain, (2) a white blood cell count of >20,000 or <1500 cells/mm(3), and (3) ileus or bowel wall thickening with ascites. Underlying disease was assessed by 2 methods: a modified Horn score and the presence of comorbid conditions. The presence of cdtA, cdtB, and the toxin A and toxin B genes was determined, and molecular subtyping was performed. RESULTS: All strains were positive for the toxin A and B genes, and 65.3% of the strains carried the cdtA and cdtB genes. Strains that carried the binary toxin genes accounted for 87.5% of the cases of severe CDD and 61.0% of the nonsevere cases (P=.23). Severity of CDD was not associated with either severe underlying disease or comorbid conditions. The strains that caused severe CDD belonged to 4 protein profile groups and >or=3 restriction endonuclease analysis (REA) groups. All (i.e., 5 of 5) strains in REA group BI, compared with none (i.e., 0 of 7) of the strains in REA group J carried the binary toxin genes (P=.001). Strains that belonged to REA groups BK and BR also carried the binary toxin genes. CONCLUSIONS: The binary toxin genes were present in nearly two-thirds of the C. difficile strains, and they were correlated with the REA group. Severity of CDD was not closely associated with a specific clone or underlying disease, but it may be associated with the presence of the binary toxin genes. Larger studies are needed to discern whether a true association exists and whether the binary toxin alters the pathogenicity of the C. difficile strain.
Assuntos
Toxinas Bacterianas/genética , Clostridioides difficile/genética , Infecção Hospitalar/microbiologia , Surtos de Doenças , ADP Ribose Transferases/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Bactérias/genética , Clostridioides difficile/classificação , Clostridioides difficile/isolamento & purificação , Enterocolite Pseudomembranosa/microbiologia , Humanos , Pessoa de Meia-Idade , Proibitinas , Estudos RetrospectivosRESUMO
Clostridium difficile causes approximately 25% of nosocomial antibiotic-associated diarrheas and most cases of pseudomembranous colitis. We evaluated C. DIFF CHEK, a new screening test that detects glutamate dehydrogenase of C. difficile. Our results showed that this test was comparable to PCR in sensitivity and specificity and outperformed bacterial culture.