Detection of Clostridium difficile in Stool Samples From Patients in the Early Period After Liver Transplantation

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doi:10.1016/j.transproceed.2007.08.047 Copyright © 2007 Elsevier Inc. All rights reserved.

Liver transplantation

Detection of Clostridium difficile in Stool Samples From Patients in the Early Period After Liver Transplantation

D. Kaweckia, b,, A. Chmuraa, M. Pacholczyka, B. Lagiewskaa, L. Adadynskia, D. Wasiaka, P. Malkowskia, A. Sawicka-Grzelakb, A. Rokoszb, A. Szymanowskab, E. Swoboda-Kopecb, M. Wroblewskab, W. Rowinskia, M. Durlikc, L. Paczekd and M. Luczakb aDepartment of General Surgery and Transplantation, Medical University of Warsaw, Warsaw, PolandbDepartment of Medical Microbiology, Medical University of Warsaw, Warsaw, PolandcDepartment of Transplantation Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, PolanddDepartment of Immunology, Transplantology and Internal Medicine, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland. Available online 20 November 2007.

Abstract

Objective

We examined the frequency of detection of Clostridium difficile (CD) toxins compared with the recovery of C. difficile in stool specimen cultures among orthotopic liver transplant (OLT) patients with nosocomial diarrhea in the early period. Materials and Methods

The study included stool samples obtained during the first 30 days after OLT in adults who were suspected of CD-associated diseases. The identification of cultured CD strains was performed by standard microbiological methods. The presence of CD toxins was assayed using a commercial immunoassay. Results

All patients were followed prospectively for CD infections from the date of OLT for the first 4 weeks after surgery. Among 54 samples, 16.7% were culture-positive for CD. CD toxins were tested on 54 samples, yielding 63% toxin-positive samples and 30% toxin- and culture-negative results. In the first week after OLT, samples from 19 patients were subjected to CD investigation. Among 19 samples positive for toxin, 52.6% of all samples were culture-negative. We analyzed 35 samples from the second to the fourth week after OLT in 31 recipients. Among 35 samples, 68.6% and 25.7% were positive for CD toxin and for culture, while 20% of samples were negative for toxin and culture. Conclusion

In our study, 63% of samples were toxin-positive with 16.7% yielding growth of CD and 30% being negative for toxins and cultures.

Address reprint requests to Dariusz Kawecki, MD, PhD, Department of Medical Microbiology, Medical University of Warsaw, 5 Chalubinskiego Street, 02-004 Warsaw, Poland.

Transplantation Proceedings Volume 39, Issue 9, November 2007, Pages 2812-2815