Skip to main content
Epidemiology and Infection logoLink to Epidemiology and Infection
. 1994 Aug;113(1):1–12. doi: 10.1017/s0950268800051402

Identification of outbreak-associated and other strains of Clostridium difficile by numerical analysis of SDS-PAGE protein patterns.

M Costas 1, B Holmes 1, M Ganner 1, S L On 1, P N Hoffman 1, M A Worsley 1, H Panigrahi 1
PMCID: PMC2271216  PMID: 8062865

Abstract

Seventy-three cultures of Clostridium difficile isolated both during, and in the period immediately following, an outbreak of infection in a group of three hospitals, were characterized by one-dimensional sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) of whole-cell proteins. Each protein pattern was characterized by the presence of one or two dense bands which were highly reproducible. The protein patterns were used as the basis for a numerical analysis which divided the strains into five phenons (electrophoretic or EP types). The majority, 60 of the 73 cultures, belonged to a single phenon which included strains from both patients and the environment. We conclude that high-resolution SDS-PAGE of proteins provides an effective method for typing C. difficile and therefore for tracing the possible spread of epidemic strains in hospitals and other institutions, thereby allowing a better understanding of the epidemiology of the organism.

Full text

PDF
1

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bartlett J. G. Antibiotic-associated diarrhea. Clin Infect Dis. 1992 Oct;15(4):573–581. doi: 10.1093/clind/15.4.573. [DOI] [PubMed] [Google Scholar]
  2. Bartlett J. G. Clostridium difficile: clinical considerations. Rev Infect Dis. 1990 Jan-Feb;12 (Suppl 2):S243–S251. doi: 10.1093/clinids/12.supplement_2.s243. [DOI] [PubMed] [Google Scholar]
  3. Bowman R. A., O'Neill G. L., Riley T. V. Non-radioactive restriction fragment length polymorphism (RFLP) typing of Clostridium difficile. FEMS Microbiol Lett. 1991 Apr 15;63(2-3):269–272. doi: 10.1016/0378-1097(91)90097-t. [DOI] [PubMed] [Google Scholar]
  4. Cartmill T. D., Orr K., Freeman R., Sisson P. R., Lightfoot N. F. Nosocomial infection with Clostridium difficile investigated by pyrolysis mass spectrometry. J Med Microbiol. 1992 Nov;37(5):352–356. doi: 10.1099/00222615-37-5-352. [DOI] [PubMed] [Google Scholar]
  5. Cartmill T. D., Shrimpton S. B., Panigrahi H., Khanna V., Brown R., Poxton I. R. Nosocomial diarrhoea due to a single strain of Clostridium difficile: a prolonged outbreak in elderly patients. Age Ageing. 1992 Jul;21(4):245–249. doi: 10.1093/ageing/21.4.245. [DOI] [PubMed] [Google Scholar]
  6. Chang T. W., Lauermann M., Bartlett J. G. Cytotoxicity assay in antibiotic-associated colitis. J Infect Dis. 1979 Nov;140(5):765–770. doi: 10.1093/infdis/140.5.765. [DOI] [PubMed] [Google Scholar]
  7. Clabots C. R., Johnson S., Bettin K. M., Mathie P. A., Mulligan M. E., Schaberg D. R., Peterson L. R., Gerding D. N. Development of a rapid and efficient restriction endonuclease analysis typing system for Clostridium difficile and correlation with other typing systems. J Clin Microbiol. 1993 Jul;31(7):1870–1875. doi: 10.1128/jcm.31.7.1870-1875.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Clabots C., Lee S., Gerding D., Mulligan M., Kwok R., Schaberg D., Fekety R., Peterson L. Clostridium difficile plasmid isolation as an epidemiologic tool. Eur J Clin Microbiol Infect Dis. 1988 Apr;7(2):312–315. doi: 10.1007/BF01963112. [DOI] [PubMed] [Google Scholar]
  9. Costas M., Holmes B., On S. L., Ganner M., Kelly M. C., Nath S. K. Investigation of an outbreak of Clostridium difficile infection in a general hospital by numerical analysis of protein patterns by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. J Clin Microbiol. 1994 Mar;32(3):759–765. doi: 10.1128/jcm.32.3.759-765.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Costas M., Holmes B., Wood A. C., On S. L. Numerical analysis of electrophoretic protein patterns of Providencia rettgeri strains from human faeces, urine and other specimens. J Appl Bacteriol. 1989 Oct;67(4):441–452. doi: 10.1111/j.1365-2672.1989.tb02515.x. [DOI] [PubMed] [Google Scholar]
  11. Degl'Innocenti R., De Santis M., Berdondini I., Dei R. Outbreak of Clostridium difficile diarrhoea in an orthopaedic unit: evidence by phage-typing for cross-infection. J Hosp Infect. 1989 Apr;13(3):309–314. doi: 10.1016/0195-6701(89)90012-1. [DOI] [PubMed] [Google Scholar]
  12. Dei R. Observations on phage-typing of Clostridium difficile: preliminary evaluation of a phage panel. Eur J Epidemiol. 1989 Sep;5(3):351–354. doi: 10.1007/BF00144837. [DOI] [PubMed] [Google Scholar]
  13. Delmée M., Avesani V. Correlation between serogroup and susceptibility to chloramphenicol, clindamycin, erythromycin, rifampicin and tetracycline among 308 isolates of Clostridium difficile. J Antimicrob Chemother. 1988 Sep;22(3):325–331. doi: 10.1093/jac/22.3.325. [DOI] [PubMed] [Google Scholar]
  14. Delmée M., Avesani V. Virulence of ten serogroups of Clostridium difficile in hamsters. J Med Microbiol. 1990 Oct;33(2):85–90. doi: 10.1099/00222615-33-2-85. [DOI] [PubMed] [Google Scholar]
  15. Delmée M., Laroche Y., Avesani V., Cornelis G. Comparison of serogrouping and polyacrylamide gel electrophoresis for typing Clostridium difficile. J Clin Microbiol. 1986 Dec;24(6):991–994. doi: 10.1128/jcm.24.6.991-994.1986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Ehret W., Turba M., Pfaller P., Heizmann W., Ruckdeschel G. Computer-aided densitometric analysis of protein patterns of Clostridium difficile. Eur J Clin Microbiol Infect Dis. 1988 Apr;7(2):285–290. doi: 10.1007/BF01963103. [DOI] [PubMed] [Google Scholar]
  17. Fekety R., Kim K. H., Brown D., Batts D. H., Cudmore M., Silva J., Jr Epidemiology of antibiotic-associated colitis; isolation of Clostridium difficile from the hospital environment. Am J Med. 1981 Apr;70(4):906–908. doi: 10.1016/0002-9343(81)90553-2. [DOI] [PubMed] [Google Scholar]
  18. Heard S. R., O'Farrell S., Holland D., Crook S., Barnett M. J., Tabaqchali S. The epidemiology of Clostridium difficile with use of a typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients. J Infect Dis. 1986 Jan;153(1):159–162. doi: 10.1093/infdis/153.1.159. [DOI] [PubMed] [Google Scholar]
  19. Johnson S., Adelmann A., Clabots C. R., Peterson L. R., Gerding D. N. Recurrences of Clostridium difficile diarrhea not caused by the original infecting organism. J Infect Dis. 1989 Feb;159(2):340–343. doi: 10.1093/infdis/159.2.340. [DOI] [PubMed] [Google Scholar]
  20. Kaatz G. W., Gitlin S. D., Schaberg D. R., Wilson K. H., Kauffman C. A., Seo S. M., Fekety R. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol. 1988 Jun;127(6):1289–1294. doi: 10.1093/oxfordjournals.aje.a114921. [DOI] [PubMed] [Google Scholar]
  21. Kamthan A. G., Bruckner H. W., Hirschman S. Z., Agus S. G. Clostridium difficile diarrhea induced by cancer chemotherapy. Arch Intern Med. 1992 Aug;152(8):1715–1717. [PubMed] [Google Scholar]
  22. Kato H., Cavallaro J. J., Kato N., Bartley S. L., Killgore G. E., Watanabe K., Ueno K. Typing of Clostridium difficile by western immunoblotting with 10 different antisera. J Clin Microbiol. 1993 Feb;31(2):413–415. doi: 10.1128/jcm.31.2.413-415.1993. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kuijper E. J., Oudbier J. H., Stuifbergen W. N., Jansz A., Zanen H. C. Application of whole-cell DNA restriction endonuclease profiles to the epidemiology of Clostridium difficile-induced diarrhea. J Clin Microbiol. 1987 Apr;25(4):751–753. doi: 10.1128/jcm.25.4.751-753.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Mahony D. E., Clow J., Atkinson L., Vakharia N., Schlech W. F. Development and application of a multiple typing system for Clostridium difficile. Appl Environ Microbiol. 1991 Jul;57(7):1873–1879. doi: 10.1128/aem.57.7.1873-1879.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. McFarland L. V., Elmer G. W., Stamm W. E., Mulligan M. E. Correlation of immunoblot type, enterotoxin production, and cytotoxin production with clinical manifestations of Clostridium difficile infection in a cohort of hospitalized patients. Infect Immun. 1991 Jul;59(7):2456–2462. doi: 10.1128/iai.59.7.2456-2462.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. McFarland L. V., Mulligan M. E., Kwok R. Y., Stamm W. E. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989 Jan 26;320(4):204–210. doi: 10.1056/NEJM198901263200402. [DOI] [PubMed] [Google Scholar]
  27. McFarland L. V., Stamm W. E. Review of Clostridium difficile-associated diseases. Am J Infect Control. 1986 Jun;14(3):99–109. doi: 10.1016/0196-6553(86)90018-0. [DOI] [PubMed] [Google Scholar]
  28. McKay I., Coia J. E., Poxton I. R. Typing of Clostridium difficile causing diarrhoea in an orthopaedic ward. J Clin Pathol. 1989 May;42(5):511–515. doi: 10.1136/jcp.42.5.511. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. McMillin D. E., Muldrow L. L. Typing of toxic strains of Clostridium difficile using DNA fingerprints generated with arbitrary polymerase chain reaction primers. FEMS Microbiol Lett. 1992 Apr 1;71(1):5–9. doi: 10.1016/0378-1097(92)90532-s. [DOI] [PubMed] [Google Scholar]
  30. Meisel-Mikolajczyk F., Sokól B. New Clostridium difficile serotypes in Poland. Eur J Epidemiol. 1991 Jul;7(4):434–436. doi: 10.1007/BF00145011. [DOI] [PubMed] [Google Scholar]
  31. Miscopein G., Delmée M., Sedallian A. Clostridium difficile: mise au point d'une méthode de typage pour les études épidémiologiques. Pathol Biol (Paris) 1991 May;39(5):551–554. [PubMed] [Google Scholar]
  32. Mulligan M. E., George W. L., Rolfe R. D., Finegold S. M. Epidemiological aspects of Clostridium difficile-induced diarrhea and colitis. Am J Clin Nutr. 1980 Nov;33(11 Suppl):2533–2538. doi: 10.1093/ajcn/33.11.2533. [DOI] [PubMed] [Google Scholar]
  33. O'Neill G. L., Beaman M. H., Riley T. V. Relapse versus reinfection with Clostridium difficile. Epidemiol Infect. 1991 Dec;107(3):627–635. doi: 10.1017/s0950268800049323. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Pantosti A., Cerquetti M., Gianfrilli P. M. Electrophoretic characterization of Clostridium difficile strains isolated from antibiotic-associated colitis and other conditions. J Clin Microbiol. 1988 Mar;26(3):540–543. doi: 10.1128/jcm.26.3.540-543.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Peerbooms P. G., Kuijt P., Maclaren D. M. Application of chromosomal restriction endonuclease digest analysis for use as typing method for Clostridium difficile. J Clin Pathol. 1987 Jul;40(7):771–776. doi: 10.1136/jcp.40.7.771. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Poxton I. R., Aronsson B., Möllby R., Nord C. E., Collee J. G. Immunochemical fingerprinting of Clostridium difficile strains isolated from an outbreak of antibiotic-associated colitis and diarrhoea. J Med Microbiol. 1984 Jun;17(3):317–324. doi: 10.1099/00222615-17-3-317. [DOI] [PubMed] [Google Scholar]
  37. Tabaqchali S., Holland D., O'Farrell S., Silman R. Typing scheme for Clostridium difficile: its application in clinical and epidemiological studies. Lancet. 1984 Apr 28;1(8383):935–938. doi: 10.1016/s0140-6736(84)92392-4. [DOI] [PubMed] [Google Scholar]
  38. Testore G. P., Pantosti A., Cerquetti M., Babudieri S., Panichi G., Gianfrilli P. M. Evidence for cross-infection in an outbreak of Clostridium difficile-associated diarrhoea in a surgical unit. J Med Microbiol. 1988 Jun;26(2):125–128. doi: 10.1099/00222615-26-2-125. [DOI] [PubMed] [Google Scholar]
  39. Toma S., Lesiak G., Magus M., Lo H. L., Delmée M. Serotyping of Clostridium difficile. J Clin Microbiol. 1988 Mar;26(3):426–428. doi: 10.1128/jcm.26.3.426-428.1988. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Wren B., Heard S. R., Tabaqchali S. Association between production of toxins A and B and types of Clostridium difficile. J Clin Pathol. 1987 Dec;40(12):1397–1401. doi: 10.1136/jcp.40.12.1397. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Epidemiology and Infection are provided here courtesy of Cambridge University Press

RESOURCES