Detection of Clostridium difficile toxins A/B in the stool specimens from patients and medical staff of the children's antituberculosis department
DOI:
https://doi.org/10.14739/2310-1210.2018.5.141724Keywords:
children, Clostridium difficile infection (CDI), rifampicin, medical staffAbstract
The objective of our research was to determine the detection frequency of C. difficile toxins in the stool specimens from children receiving long-term treatment with rifampicin and in health care workers treating these children in a separate anti-tuberculosis hospital.
Materials and methods. 139 children with the average age of 13.6 were examined; all of them had an infiltrative pulmonary tuberculosis and received long-term treatment with rifampicin at the Zaporizhzhia Regional Tuberculosis Dispensary. Also, 32 medical workers were examined and divided into high and low risk groups of C. difficile infection depending on the closeness of their contacts with children at the department. To detect C. difficile toxins A/B in the stool an ELI method was applied using the ELISA test system (Diagnostic Automation, Inc.,Calabasas,USA). The amount of toxins ranged from 1 ng and more in 1 ml of feces sample was considered as diagnostic.
Results. 74 (53 %) children out of the 139 had a diagnostic titer of C. difficile toxins in their stool specimens. Among them, 49 (66 %) children had recurrent diarrhea, syndrome of abdominal pain without diarrhea was observed in 20 (27 %) and asymptomatic carrier state of CDI detected by laboratory tests was defined in 5 (7 %) children. Among 32 medical workers in the same department 6 (18.8 %) of them were positive for C. difficile toxins. It is noteworthy that three of them had received antibiotics during the last month prior to the study.
Conclusions. In the context of professional contacts with symptomatic or asymptomatic CDI children there is the risk of intestinal contamination among the health workers who intake antibiotics regardless of contacts closeness and total years of service at the hospital. At the same time, patients without diarrhea and, possibly, health workers of the department can be considered as an additional reservoir of C. difficile.
References
Lessa, F. C., Mu, Y., Bamberg, W. M., Beldavs, Z. G., Dumyati, G. K., Dunn, J. R., Farley, M. M., et al. (2015). Burden of Clostridium difficile infection in the United States. N Engl J Med, 372(9), 825–834. doi: 10.1056/NEJMoa1408913.
Van Dorp, S. M., Notermans, D. W., Alblas, J., Gastmeier, P., Mentula, S., Nagy, E., et al. (2016). Surveillance and outbreak report Survey of diagnostic and typing capacity for Clostridium difficile infection in Europe, 2011 and 2014. Euro Surveillance journal, 21(29). doi:10.2807/1560-7917. ES.2016.21.29.30292.
Balsells, E., Filipescu, T., Kyaw, M. H., Wiuff, C., Campbell, H., & Nair, H. (2016). Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations. J Glob Health, 6(2), 020410. doi: 10.7189/jogh.06.020410.
Domeniconi, G., Serafino, S., Migone, De Amicis., M., Formica., S., Lanzoni, M., et al. (2016). Clostridium difficile infection epidemiology and management: Comparison of results of a prospective study with a retrospective one in a reference teaching and research hospital in Northern Italy. Am J Infect Control, 44(11), 1214–1218. doi: 10.1016/j.ajic.2016.05.003.
Kumar, N., Miyajima, F., He, M., Roberts, P., Swale, A., Ellison, L., et al. (2016). Genome-Based Infection Tracking Reveals Dynamics of Clostridium difficile Transmission and Disease Recurrence. Clin Infect Dis, 62(6), 746–752, doi: 10.1093/cid/civ1031.
Tabak, Y. P., Johannes, R. S., Sun, X., Nunez, C. M., & McDonald, L. C. (2015). Predicting the risk for hospital-onset Clostridium difficile infection (HO-CDI) at the time of inpatient admission: HO-CDI risk score. Infect Control Hosp Epidemiol, 36(6), 695–701. doi: 10.1017/ice.2015.37.
Stoesser, N., Eyre, D. W., Quan, T. P., Godwin, H., Pill, G., Mbuvi, E., et al. (2017). Epidemiology of Clostridium difficile in infants in Oxfordshire, UK: Risk factors for colonization and carriage, and genetic overlap with regional C. difficile infection strains. PLoS One, 12(8). doi: 10.1371/journal.pone.0182307.
Peng, Z., Jin, D., Kim, H. B., Stratton, C. W., Wu, B., Tang, Y. W., & Sun, X. (2017). Update on Antimicrobial Resistance in Clostridium difficile: Resistance Mechanisms and Antimicrobial Susceptibility Testing. J Clin Microbiol, 55(7), 1998–2008. doi: 10.1128/JCM.02250-16.
Haun, N., Hooper-Lane, C., & Safdar, N. (2016). Healthcare Personnel Attire and Devices as Fomites: A Systematic Review Infect Control Hosp Epidemiol, 37(11), 1367–1373. doi:10.1017/ice.2016.192.
Furuya-Kanamori, L., Clements, A. C. A., Foster, N. F., Huber, C. A., Hong, S., Harris-Brown, T., et al. (2017). Asymptomatic Clostridium difficile colonization in two Australian tertiary hospitals, 2012–2014: prospective, repeated cross-sectional study. Clin Microbiol Infect, 23(1), 48.e1–48.e7. doi: 10.1016/j.cmi.2016.08.030.
Zacharioudakis, I. M., Zervou, F. N., Pliakos, E. E., Ziakas, P. D., & Mylonakis, E. (2015). Colonization with toxinogenic C. difficile upon hospital admission, and risk of infection: a systematic review and meta-analysis. Am J Gastroenterol, 110, 381–390.
Alasmari, F., Seiler, S. M., Hink, T., Burnham, C. A., & Dubberke, E. R. (2014). Prevalence and risk factors for asymptomatic Clostridium difficile carriage. Clin Infect Dis, 59(2), 216–222. doi: 10.1093/cid/ciu258.
Dubberke, E. R., Carling, P., Carrico, R., Donskey, C. J., Loo, V. G., McDonald, L. C., et al. (2014) Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 Update. Infect Control Hosp Epidemiol, 35(6), 628–645. doi: 10.1086/676023.
Napolitano, L. M., & Edmiston, Jr., C. E. (2017). Clostridium difficile disease: Diagnosis, pathogenesis, and treatment update. Surgery, 162(2), 325–348. doi: 10.1016/j.surg.2017.01.018.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)
