sodium-dodecyl-sulfate and Enterocolitis--Pseudomembranous

One hundred forty-five cultures of Clostridium difficile, including strains from an apparent nosocomial outbreak of infection, were characterized by one-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell proteins. Each protein pattern was characterized by the presence of one to three dense bands which were highly reproducible. The first 100 strains (in chronological order) were used as the basis for a numerical analysis which divided the strains into 17 phenons (EP types 1 to 17). The protein patterns of the remaining 45 strains were identified to type by comparing their individual patterns against a data base made up of the protein patterns of the first 100 strains. EP type 1 was the most common, with 70 of 139 (50%) patient isolates having this pattern type, and it accounted for 26 of 35 strains (74%) from patients in a medical teaching ward from which the outbreak was believed to have originated. This type was also found as a high proportion of isolations in a number of other medical and oncology wards, but the majority of these isolates occurred subsequent to the isolations on the initial outbreak ward. This technique can therefore provide a method for tracing the possible spread of epidemic strains in hospitals and other institutions and may contribute to a better understanding of the epidemiology of C. difficile.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Proteins; Bacterial Toxins; Bacterial Typing Techniques; Clostridioides difficile; Cross Infection; Disease Outbreaks; Electrophoresis, Polyacrylamide Gel; Enterocolitis, Pseudomembranous; Female; Hospitals, General; Humans; Male; Middle Aged; Recurrence; Sodium Dodecyl Sulfate; Time Factors

Epidemiological studies of Clostridium difficile diarrhoeal disease have been hindered by the lack of a typing scheme for this organism. A typing method based on the incorporation of sulphur-35-labelled methionine into cellular proteins and their separation by sodium dodecylsulphate/polyacrylamide gel electrophoresis showed clear pattern differences between strains, and nine distinct groups within the C difficile species were established. 98% of 250 clinical strains derived from four hospitals were typable. Group X was the commonest group and was associated with outbreaks of pseudomembranous colitis and antibiotic-associated colitis in two hospitals. Groups A-D were isolated predominantly from mothers and newborn infants. In outbreaks of antibiotic-associated colitis in oncology and orthopaedic wards the same strains, group X and group E, respectively, were isolated from patients and their environment, providing strong evidence of cross-infection between patients and of hospital acquisition of C difficile.

Topics: Adult; Anti-Bacterial Agents; Autoradiography; Bacterial Proteins; Bacteriological Techniques; Clostridium; Colitis; Cross Infection; Electrophoresis, Polyacrylamide Gel; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Methionine; Sodium Dodecyl Sulfate; Sulfur Radioisotopes