OBJECTIVEThe aim of this study was to investigate the prevalence of Clostridium difficile (C. difficile) infection and the risk factors for acquisition of C. difficile-associated diarrhea (CDAD) among cancer patients who received chemotherapy or radiation therapy.

METHODSWe analyzed 277 stool samples from cancer patients with diarrhea between Sep 2010 and Dec 2011 in our hospital. Stool C. difficile toxin A/B test, stool culture for C. difficile and routine stool examination were performed. In addition, the risk factors for CDAD were investigated in a set of 41 C. difficile toxin-positive cancer patients and 82 matched C. difficile toxin-negative controls by univariate analysis and multivariate analysis.

RESULTSOut of a total of 277 cancer patients with diarrhea, 41 (14.8%) were C. difficile toxin-positive. Among these 41 cases, 11 (26.8%, 11/41) were C. difficile culture-positive. Univariate analysis showed that antibiotics use (P = 0.853), proton pump inhibitor use (P = 0.718), hypoproteinemia (P = 0.139) and white blood cell count (P = 0.454) did not appear to be associated with acquisition of CDAD in cancer patients. However, receiving chemotherapy (P = 0.023), receiving radiotherapy (P = 0.003), a positive fecal occult blood test result (P = 0.005) and the presence of fecal leukocytes (P = 0.007) showed close association with acquisition of CDAD in cancer patients. Multivariate analysis showed that receiving chemotherapy (OR, 8.308; 95% CI, 1.997-34.572; P = 0.004) and a positive result of fecal occult blood test (OR, 8.475; 95% CI, 1.463-49.109; P = 0.017) were independent risk factors for acquisition of CDAD among cancer patients.

CONCLUSIONSOur results support that receiving chemotherapy and a positive fecal occult blood test result are independent risk factors for acquisition of CDAD among cancer patients. Cancer patients who are at high-risk for CDAD should take stool C. difficile toxin A/B test and stool culture for C. difficile regularly and prevention of CDAD.

Clostridium difficile ; Diarrhea ; epidemiology ; microbiology ; Enterocolitis, Pseudomembranous ; epidemiology ; Humans ; Neoplasms ; epidemiology ; microbiology ; Risk Factors

Aged ; Clostridium difficile ; Diarrhea ; microbiology ; Enterocolitis, Pseudomembranous ; complications ; diagnosis ; Humans ; Male

Toxic megacolon is a rare clinical complication of fulminant Clostridium difficile infection. The mortality rate of fulminant C. difficile infection is reported to be as high as 50%. Fecal microbiota transplantation is a highly effective treatment in patients with recurrent or refractory C. difficile infection. However, there are few published articles on the use of such transplantation for fulminant C. difficile infection. Here, we report on a patient with toxic megacolon complicated by C. difficile infection who was treated successfully with fecal microbiota transplantation.
Aged ; *Clostridium difficile ; Enterocolitis, Pseudomembranous/*complications ; Fecal Microbiota Transplantation/*methods ; Feces/*microbiology ; Humans ; Male ; Megacolon, Toxic/*microbiology/*therapy

Clostridium difficile-associated diarrhea (CDAD) is common among hospital-acquired bacterial diarrhea, its mortality and morbidity show an increasing trend in recent years. Improper antimicrobial drug use is one of the key reasons. Adequate hand hygiene of healthcare workers, thorough disinfection of hospital environment, and appropriate isolation of patients are effective measures to prevent the outbreak of hospital-aquired CDAD.
Clostridium difficile ; physiology ; Cross Infection ; microbiology ; mortality ; prevention & control ; Diarrhea ; microbiology ; mortality ; prevention & control ; Enterocolitis, Pseudomembranous ; microbiology ; mortality ; prevention & control ; Humans ; Infection Control

Advances in sequencing technology and the development of metagenomics have opened up new ways to investigate the microorganisms inhabiting the human gut. The intestinal microbiota confer protection against pathogens, contribute to the maturation of the immune system, and regulate host metabolism. The composition of gut microbiota in early life is influenced by mode of birth, diet, and antibiotics. Decreased biodiversity and alterations in the composition of the intestinal microbiota have been observed in many diseases including obesity, neonatal necrotizing enterocolitis, inflammatory bowel disease, and recurrent Clostridium difficile infection. Therapeutic options for the diseases linked to imbalance in the microbiota include modifying the gut microbiota through diet, probiotics, and fecal transplants.
Animals ; Anti-Bacterial Agents/therapeutic use ; Clostridium difficile/isolation & purification/pathogenicity ; Enterocolitis, Pseudomembranous/drug therapy/microbiology/pathology ; Fatty Liver/etiology/microbiology ; Humans ; Inflammatory Bowel Diseases/etiology/microbiology ; Intestines/*microbiology ; *Microbiota ; Obesity/etiology/microbiology

BACKGROUND: ChromID Clostridium difficile agar (IDCd; bioMerieux SA, France) is a recently developed chromogenic medium for rapid and specific isolation of C. difficile. We compared the performance of IDCd with that of Clostridium difficile Selective Agar (CDSA). METHODS: A total of 530 fresh stool specimens were collected from patients with clinical signs compatible with C. difficile infection, and cultures for C. difficile were performed on IDCd and CDSA. C. difficile colonies were identified by spore staining, odor, use of an ANI identification test kit (bioMerieux SA), and multiplex PCR for tcdA, tcdB, and tpi. RESULTS: The concordance rate between IDCd and CDSA was 90.6% (480/530). The positivity rates on IDCd on days 1 and 2 (55.6% and 85.0%, respectively) were significantly higher than those on CDSA (19.4% and 75.6%, respectively) (P<0.001 for day 1 and P=0.02 for day 2), but the detection rates on IDCd and CDSA on day 3 were not different (89.4% vs. 82.8%, P=0.0914). On day 3, the recovery rates for non-C. difficile isolates on IDCd and CDSA were 30.2% (160/530) and 22.1% (117/530), respectively (P=0.0075). Clostridium spp. other than C. difficile were the most prevalent non-C. difficile isolates on both media. CONCLUSIONS: The culture positivity rates on IDCd and CDSA were not different on day 3 but IDCd may allow for rapid and sensitive detection of C. difficile within 2 days of cultivation.
Agar/*chemistry ; Bacterial Proteins/genetics ; Bacterial Toxins/genetics ; Clostridium difficile/genetics/*isolation & purification ; DNA, Bacterial/analysis ; Enterocolitis, Pseudomembranous/diagnosis/microbiology ; Enterotoxins/genetics ; Feces/*microbiology ; Humans ; Multiplex Polymerase Chain Reaction ; Reagent Kits, Diagnostic ; Triose-Phosphate Isomerase/genetics

Clostridium difficile, an anaerobic, spore-forming, gram-positive, rod-shaped bacterium, is the most common nosocomial pathogen causing pseudomembranous colitis. C. difficile is not intrinsically invasive and rarely infects extraintestinal sites. The bacterium, therefore, is not commonly detected in blood cultures. Here, we report a case of C. difficile bacteremia in a patient who had underwent loop ileostomy because of rectal obstruction following metastatic colon cancer originated from prostate cancer.
Anti-Bacterial Agents/*therapeutic use ; Bacteremia/*drug therapy ; Clostridium difficile/genetics/*isolation & purification ; Colonic Neoplasms/pathology/secondary ; Enterocolitis, Pseudomembranous/drug therapy/microbiology ; Humans ; Ileostomy ; Male ; Middle Aged ; Prostatic Neoplasms/pathology ; RNA, Ribosomal, 16S/chemistry/genetics ; Sequence Analysis, RNA

Clostridium difficile, an anaerobic, spore-forming, gram-positive, rod-shaped bacterium, is the most common nosocomial pathogen causing pseudomembranous colitis. C. difficile is not intrinsically invasive and rarely infects extraintestinal sites. The bacterium, therefore, is not commonly detected in blood cultures. Here, we report a case of C. difficile bacteremia in a patient who had underwent loop ileostomy because of rectal obstruction following metastatic colon cancer originated from prostate cancer.
Anti-Bacterial Agents/*therapeutic use ; Bacteremia/*drug therapy ; Clostridium difficile/genetics/*isolation & purification ; Colonic Neoplasms/pathology/secondary ; Enterocolitis, Pseudomembranous/drug therapy/microbiology ; Humans ; Ileostomy ; Male ; Middle Aged ; Prostatic Neoplasms/pathology ; RNA, Ribosomal, 16S/chemistry/genetics ; Sequence Analysis, RNA

Clostridium difficile (C. difficile) is a common causative agent of pseudomembranous colitis (PMC). C. difficile-associated diarrhea (CDAD) ranges from mild diarrhea to life threatening PMC. Recently, a highly virulent strain of C. difficile polymerase chain reaction ribotype 027 was found in North America, Europe, and Japan. A 52-yr-old woman with anti-tuberculosis medication and neurogenic bladder due to traffic accident experienced five episodes of C. difficile PMC after taking antibiotics for pneumonia along with septic shock and acute renal failure. She was readmitted to the intensive care unit and treated with oral vancomycin with refractory of oral metronidazole, inotropics and probiotics for over 60 days. C. difficile isolated both at the first and the last admission was identified as C. difficile ribotype 027 by ribotyping, toxinotyping, and tcdC gene sequencing, which turned out the same pathogen as the epidemic hypervirulent B1/NAP1 strain. This is the first case of C. difficile PCR ribotype 027 in Korea. After discharge, she was maintained on probiotics and rifaximin for 3 weeks. She had no relapse for 6 months.
Accidents, Traffic ; Antitubercular Agents/therapeutic use ; Base Sequence ; Clostridium difficile/*classification/genetics/isolation & purification ; Enterocolitis, Pseudomembranous/*diagnosis/drug therapy/*microbiology ; Female ; Humans ; Kidney Failure, Acute/diagnosis ; Korea ; Middle Aged ; Molecular Sequence Data ; Polymerase Chain Reaction ; Ribotyping ; Shock, Septic/diagnosis

Clostridium difficile is a significant nosocomial and community-acquired pathogen, and is the leading cause of antibiotic-induced diarrhea associated with high morbidity and mortality. Given that the treatment outcome depends on the severity of C. difficile infection (CDI), we aimed to establish an efficient method of assessing severity, and focused on the stool biomarker fecal calprotectin (FC). FC directly reflects the intestinal inflammation status of a patient, and can aid in interpreting the current guidelines, which requires the integration of indirect laboratory parameters. The distinction of 80 patients with CDI versus 71 healthy controls and 30 severe infection cases versus 50 mild cases was possible using FC as a marker. The area under the receiver operating characteristic curves were 0.821 and 0.746 with a sensitivity of 75% and 70% and specificity of 79% and 80%, for severe versus mild cases, respectively. We suggest FC as a predictive marker for assessing CDI severity, which is expected to improve the clinical management of CDI.
Aged ; Area Under Curve ; Biomarkers/analysis ; Clostridium difficile/*isolation & purification ; Enterocolitis, Pseudomembranous/diagnosis/microbiology/*pathology ; Enzyme-Linked Immunosorbent Assay ; Feces/*chemistry ; Female ; Humans ; Leukocyte L1 Antigen Complex/*analysis ; Male ; Middle Aged ; ROC Curve ; Severity of Illness Index