Document Detail


Is Clostridium difficile a pathogen in the newborn intensive care unit? A prospective evaluation.
MedLine Citation:
PMID:  9373839     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to investigate (1) the presence of Clostridium difficile toxin in patients in the newborn intensive care unit and (2) the association of C. difficile toxin with gastrointestinal tract symptoms in this population. STUDY DESIGN: A prospective, masked study was done in which twice-weekly stool specimens of subjects hospitalized in a newborn intensive care unit during a 4-month period were analyzed for C. difficile toxin A by enzyme immunoassay. Daily data collection included infant clinical status, stool frequency and character, presence of gastrointestinal tract symptoms, and actions taken for gastrointestinal tract symptoms. Infants hospitalized 5 or more days who had at least two stool assays comprised the study population. For data analysis, an infant with C. difficile toxin-positive status was defined as an infant with two or more toxin-positive stools. RESULTS: Of 87 infants who met study criteria, 42 (48%) had toxin-negative and 45 (52%) toxin-positive results on at least one specimen. Of the infants with toxin-positive findings, 27 (31%) had two or more positive stool assays and comprised the comparison group. The infants with toxin-positive results were smaller, less mature, and had a longer hospital stay than infants with toxin-negative results (p < 0.001). Infants with toxin-positive findings had more days per infant with frequent (> 6) stools and abnormal stools (p < 0.001). The total number of symptom days was 8.2 +/- 5.7 in infants in the toxin-positive group versus 2.2 +/- 2.2 in those in the toxin-negative group (p < 0.001). The mean number of times stools were sent for evaluation and culture was greater in infants with toxin-positive findings (p < or = 0.012) whereas there was no difference in the number of times oral feedings were withheld from infants or infants had abdominal films obtained (p > or = 0.18). CONCLUSIONS: Infants hospitalized in our newborn intensive care unit frequently had stools positive for C. difficile toxin A. When compared with infants with toxin-negative findings, infants with colonization had an increased number of days with gastrointestinal tract symptoms.
Authors:
D Enad; D Meislich; N L Brodsky; H Hurt
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  17     ISSN:  0743-8346     ISO Abbreviation:  J Perinatol     Publication Date:    1997 Sep-Oct
Date Detail:
Created Date:  1997-12-24     Completed Date:  1997-12-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  355-9     Citation Subset:  IM    
Affiliation:
Division of Neonatology, Albert Einstein Medical Center, Philadelphia, PA 19141, USA.
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MeSH Terms
Descriptor/Qualifier:
Bacterial Toxins*
Case-Control Studies
Clostridium difficile / isolation & purification*
Cross Infection / epidemiology,  microbiology*
Enterocolitis, Pseudomembranous / diagnosis,  epidemiology*
Enterotoxins / analysis*
Feces / microbiology
Humans
Immunoenzyme Techniques
Infant, Newborn
Intensive Care Units, Neonatal
Length of Stay
Prospective Studies
Time Factors
Chemical
Reg. No./Substance:
0/Bacterial Toxins; 0/Enterotoxins; 0/tcdA protein, Clostridium difficile

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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