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Spatial and Temporal Analysis of Clostridium difficile Infection in Patients at a Pediatric Hospital in California

Published online by Cambridge University Press:  21 June 2016

Carmen E. Rexach ,
Yajarayma J. Tang-Feldman  and
Stuart H. Cohen
Carmen E. Rexach*
Affiliation:
Division of Natural Sciences, University of California, Merced, Merced, California
Yajarayma J. Tang-Feldman
Affiliation:
Division of Infectious and Immunologic Diseases, University of California Davis Medical Center, Sacramento, California
Stuart H. Cohen
Affiliation:
Division of Infectious and Immunologic Diseases, University of California Davis Medical Center, Sacramento, California
*
University of California, Merced, Division of Natural Sciences, PO. Box 2039, Merced, CA 95344., [email protected]
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Abstract

Objective:

To examine the usefulness of temporal and spatial analysis in identifying nosocomial transmission of Clostridium difficile among pediatric patients hospitalized on four wards at The Children's Hospital of Central California from September 8,1998, to January 16,1999.

Design:

Stool specimens obtained from the clinical microbiology laboratory during the study period were tested by culture and latex agglutination for C. difficile. Polymerase chain reaction was used to identify toxin genes. Isolates obtained were mapped to a grid for each ward and were analyzed using the Knox test. Results were compared with DNA fingerprints generated by arbitrarily primed polymerase chain reaction.

Results:

Total occupancy of these 4 wards was 438 during the study period. Stool specimens were available for 256 (58%) of these patients, yielding 67 C. difficile isolates and generating 2,211 case pairs for analysis by the Knox test. After stratification by toxin status, 5 clustered pairs of toxigenic isolates were identified on 1 of the wards by this method. Fingerprint analysis identified 4 clusters with indistinguishable banding patterns on 2 of the 4 wards. Two of the identified clusters were toxigenic and 2 were nontoxigenic. None of these clusters corresponded to clusters identified by the Knox test.

Conclusions:

The Knox test is an ineffective method for identifying cases resulting from nosocomial transmission of C. difficile in a pediatric setting due to the persistence of C. difficile spores and the unique environment of a pediatric hospital. Molecular analysis remains the most effective method.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 8 , August 2005 , pp. 691 - 696
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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