{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T20:51:48Z","timestamp":1791060708358,"version":"4.1.0"},"reference-count":47,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":2892,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2007,2]]},"abstract":"<jats:sec id=\"S0195941700051079_abs1\"><jats:title>Background.<\/jats:title><jats:p>Recent outbreaks of severe cases of<jats:italic>Clostridium difficile<\/jats:italic>-associated diarrhea (CDAD) reported in North America, the United Kingdom, and The Netherlands have emphasized the importance of an ongoing epidemiological surveillance of CDAD.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700051079_abs2\"><jats:title>Objective.<\/jats:title><jats:p>To determine the epidemiology of CDAD over the years 2000-2004 and the rate of nosocomial transmission of<jats:italic>C. difficile<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700051079_abs3\"><jats:title>Design.<\/jats:title><jats:p>Retrospective survey of inpatients with CDAD and molecular characterization of the strains isolated.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700051079_abs4\"><jats:title>Setting.<\/jats:title><jats:p>A 760-bed teaching hospital.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700051079_abs5\"><jats:title>Methods.<\/jats:title><jats:p>All CDAD cases diagnosed from January 1, 2000, to December 31, 2004, were reviewed. A CDAD case was defined as diarrhea in a hospitalized patient who had a stool specimen that tested positive for<jats:italic>C. difficile<\/jats:italic>cytotoxin or had a positive toxigenic culture result. CDAD was considered to be severe if a patient fulfilled at least 1 of the following 3 criteria: (1) presence of a fever (defined as temperature higher than 38.5\u00b0C), abdominal pain, and leukocyte count greater than 10,000 cells\/mm<jats:sup>3<\/jats:sup>; (2) endoscopically or histologically proven pseudomembranous colitis; or (3) complications (defined as death with C.<jats:italic>difficile<\/jats:italic>infection as the primary or a contributing cause, toxic megacolon, perforation, toxic shock, and\/or colectomy). CDAD was considered community-acquired if the diarrhea occurred in the patient within 72 hours after admission and if the patient had no history of hospitalization in the previous month; otherwise, CDAD was considered healthcare-associated. All the strains isolated were serogrouped and were characterized by toxinotyping and PCR ribotyping. Detection of toxin A, toxin B, and binary toxin was performed by PCR.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700051079_abs6\"><jats:title>Results.<\/jats:title><jats:p>One hundred fifty-one cases of CDAD were diagnosed; 147 clinical records could be reviewed, and 131 strains were studied. The overall incidence of CDAD was 1.1 cases per 1,000 patients admitted, but incidence rates were higher in 2003-2004, compared with 2000-2002 (<jats:italic>P<\/jats:italic>= .017). Diarrhea was community acquired in 28 patients (19%). For patients with healthcare-associated CDAD, transmission of the strain from patient to patient (ie, infection with a strain of the same serogroup and PCR ribotype as the strain isolated from another patient hospitalized in the same ward or in a linked ward in the previous 2 months) was demonstrated in 12 cases (10.1%). Eleven percent of strains were positive for binary toxin. Binary toxin-positive strains were associated with more-severe diarrhea (<jats:italic>P<\/jats:italic>= .01 ) and with a higher case-fatality rate (<jats:italic>P<\/jats:italic>= .03). A specific clone of<jats:italic>C. difficile<\/jats:italic>(serogroup H, PCR ribotype sa026) accounted for 35 (26.7%) of all the strains isolated, but this clone was found both in healthcare-associated and community-acquired cases. Three strains belonged to toxinotype III, but only 1 was related to the hypervirulent clone involved in recent outbreaks.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700051079_abs7\"><jats:title>Conclusion.<\/jats:title><jats:p>The incidence of CDAD is low in our hospital, and cross-infection is limited. 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