Diarrhoea associated with Clostridium difficile in a hospital population.

The incidence of disease associated with Clostridium difficile was investigated in a general hospital population over a period of six months. In 26 (14.5%) of 179 patients studied, C. difficile was either isolated or faecal cytotoxin was detected. The incidence of other enteropathogenic bacteria, except Aeromonas hydrophila, was low. Faecal cytotoxin was not detected in nine patients (35%), and non-cytotoxigenic strains of C. difficile were isolated from these patients. In seven patients, a selective broth was required to isolate C. difficile, suggesting their presence in low numbers. Although some C. difficile diarrhoeal disease which was not associated with antibiotic therapy was recorded, prior exposure to antibiotic agents still appears to be the major predisposing factor in this population. Faecal cytotoxin detection, sigmoidoscopy, and rectal biopsy were not reliable investigations for disease associated with C. difficile; hence, we advocate increased emphasis on isolation of the causative organism. Routine culturing for C. difficile in a hospital population appears to be warranted.