First Australian isolation of epidemic Clostridium difficile PCR ribotype 027

We report the first isolation in Australia of a hypervirulent epidemic strain of Clostridium difficile, PCR ribotype 027. It was isolated from a 43-year-old woman with a permanent ileostomy, who appears to have been infected while travelling in the United States. The isolate was positive for toxin A, toxin B and binary toxin, and resistant to fluoroquinolone antimicrobials, and had characteristic deletions in the tcdC gene. All diagnostic laboratories and health care facilities in Australia should now be on high alert for this organism

Ciprofloxacin and Clostridium difficile-associated diarrhea

Letter to the Edito

Extended spectrum cephalosporins and Clostridium difficile

There is little information about how commonly the newer cephalosporins cause diarrhoea due to Clostridium difficile. In this study of 111 patients with C. difficile-associated diarrhoea, 106 had received antimicrobial agents in the four weeks before detection of C. difficile. The relative risk for each antimicrobial agent was greatest with clindamycin, followed by cefotaxime, cephamandole and ceftriaxone. There was no statistically significant difference in risk between the cephalosporins evaluated. Narrower spectrum penicillins, anti-pseudomonal penicillins and aminoglycosides were not potent inciting agents

Clostridium difficile-associated diarrhoea

Clostridium difficile is an important nosocomial pathogen and the most frequently diagnosed cause of infectious hospital-acquired diarrhoea. Toxigenic strains usually produce toxin A and toxin B, which are the primary virulence factors of C. difficile. Some recently described strains produce an additional toxin, an adenosine-diphosphate ribosyltransferase known as binary toxin, the role of which in pathogenicity is unknown. There has been concern about the emergence of a hypervirulent fluoroquinolone-resistant strain of C. difficile in North America and Europe. The use of fluoroquinolone antimicrobials appears to be acting as a selective pressure in the emergence of this strain. In this review, we describe the current state of knowledge about C. difficile as a cause of diarrhoeal illness