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Colonisation and transmission of Clostridium difficile in healthy individuals examined by PCR ribotyping and pulsed-field gel electrophoresis

H. KATO, H. KITA, T. KARASAWA, T. MAEGAWA, Y. KOINO, H. TAKAKUWA^*, T. SAIKAI, K. KOBAYASHI^*, T. YAMAGISHI and S. NAKAMURA

Department of Bacteriology, *First Department of Internal Medicine, School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8640, General Service Corps, Kanazawa Station, Ground Self Defence Force, 1-8 Noda-machi, Kanazawa 921-8520 and Department of Laboratory Science, School of Health Science, School of Medicine, Kanazawa University, 5-11-80 Kodatsuno, Kanazawa 920-0942, Japan

Corresponding author: S. Nakamura (e-mail: nakamura{at}med.kanazawa-u.ac.jp).

Received 15 Dec. 2000; accepted 8 Feb. 2001.

Abstract

Healthy adults who had not been exposed to antimicrobial agents for the preceding 4 weeks were examined for intestinal carriage of Clostridium difficile. The 1234 individuals examined were composed of seven groups: three classes of university students, hospital workers at two hospitals, employees of a company and self-defence force personnel at a local station. Overall, 94 (7.6%) individuals were positive for C. difficile by faecal culture but carriage rates among the study groups ranged from 4.2% to 15.3%. Typing by PCR ribotyping and pulsed-field gel electrophoresis demonstrated clusters of carriers colonised by a single type in each of three groups, indicating that cross-transmission of C. difficile can occur in community settings. Follow-up culture was performed on 38 C. difficile-positive individuals and C. difficile was isolated again from 12 (32%) of them 5–7 months after the initial culture; six (50%) of these 12 individuals had a new strain on repeat culture. Two or more family members were C. difficile-positive in five of 22 families examined. C. difficile with an identical type was isolated from persons within a family in only one family. These results suggest that intestinal carriage by healthy adults may play a role as a reservoir for community-acquired C. difficile-associated diarrhoea, but that cross-transmission of C. difficile does not occur frequently among family members at home.

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