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Toxigenic Clostridium difficile carriage in general practice: results of a laboratory-based cohort study.
Clin Microbiol Infect. 2019 Jan 04;:
Authors: Barbut F, Day N, Bouée S, Youssouf A, Grandvoinnet L, Lalande V, Couturier J, Eckert C
Abstract
Stool samples from 2541 patients attending their general practitioner (GP) for diarrhoea or other gastrointestinal disorders were systematically tested for C. difficile irrespective of physician request. The results show that toxigenic C. difficile carriage is frequent in general practice but remains under-recognized.
OBJECTIVES: The reported rates of community-acquired Clostridium difficile infections (CDIs) have been increasing. However, the true burden of the disease in the general practice is still unknown in France. Our objective was to determine the incidence of toxigenic C. difficile (CD) carriage and the percentage of stool samples prescribed by general practitioners (GPs) which contained free C. difficile toxins .
METHODS: During an eleven-month period, all stool samples submitted for any enteric pathogen detection to 15 different private laboratories in Paris and the surrounding areas were tested for C. difficile, irrespective of the general practitioners' request. A clinical questionnaire was completed for each patient. Stool samples were screened using a rapid simultaneous GDH and toxins A/B detection test: any positive result (GDH or toxin) was further confirmed by the stool cytotoxicity assay (CTA) on MRC-5 cells and by toxigenic culture (TC) at a central laboratory. C. difficile isolates were characterized by PCR ribotyping.
RESULTS: 2541 patients (1295 female, 1246 male) were included. The incidence of patients with a positive toxigenic culture and a positive CTA was 3.27% [CI95% 2.61-4.03] and 1.81% [CI95% 1.33-2.41], respectively. GPs requested CD testing in only 12.93% of the stool samples, detecting 52.30% of all TC-positive patients. The 83 toxigenic C. difficile strains belonged to 36 different PCR-ribotypes.
CONCLUSIONS: Toxigenic C. difficile carriage is frequent in general practice but remains under-recognized. It may affect young patients without previous antimicrobial therapy or hospitalisation.
PMID: 30616013 [PubMed - as supplied by publisher]