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Journal of Clinical Microbiology, October 1998, p. 2957-2963, Vol. 36, No. 10
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Comparison of Restriction Enzyme Analysis, Arbitrarily Primed PCR, and Protein Profile Analysis Typing for Epidemiologic Investigation of an Ongoing Clostridium difficile Outbreak

Mary Ellen Rafferty,1 Aldona L. Baltch,1,* Raymond P. Smith,1 Lawrence H. Bopp,1 Carol Rheal,1 Fred C. Tenover,2 George E. Killgore,2 David M. Lyerly,3,dagger Tracy D. Wilkins,3 Dianna J. Schoonmaker,4 George E. Hannett,4 and Mehdi Shayegani4

Stratton Veterans Affairs Medical Center and Albany Medical College,1 and Wadsworth Center, New York State Department of Health,4 Albany, New York; Centers for Disease Control and Prevention, Atlanta, Georgia2; and Department of Biochemistry, Virginia Polytechnic Institute and State University, Blacksburg, Virginia3

Received 17 February 1998/Returned for modification 27 April 1998/Accepted 29 June 1998

During an outbreak of diarrhea in a general hospital in 1992, 166 Clostridium difficile isolates from 102 patients were typed by restriction enzyme analysis (REA), arbitrarily primed PCR (AP-PCR), and protein profile analysis (PP) techniques. A total of 18 types and 5 subtypes were identified by REA, 32 types were identified by AP-PCR, and 9 types were identified by PP. Analysis of the data indicated the presence of a predominant strain among 76, 75, and 84% of the isolates by REA, AP-PCR, and PP, respectively. Subsequently, 45 C. difficile isolates which had been collected in 1990 from 33 patients in the same hospital following a significant increase in the number of cases of diarrhea caused by C. difficile were studied by REA, AP-PCR, and PP typing techniques. Thirteen types and one subtype were identified by REA, 12 types were identified by AP-PCR, and 5 types were identified by PP. As with the isolates from 1992, a dominant strain was identified. This strain was represented by 53, 64, and 70% of the total number of isolates when the strains were typed by REA, AP-PCR, and PP, respectively. Every isolate (210 of 211) from both 1990 and 1992 that was available for typing was typeable by all three methods. Furthermore, the same dominant strain was identified in both 1990 and 1992 by each method. This study demonstrates that each of the three typing methods can be useful in epidemiologic investigations of C. difficile outbreaks and that one strain can be dominant in an institution over a number of years.

* Corresponding author. Mailing address: Infectious Disease Section, 111D, Stratton VA Medical Center, 113 Holland Ave., Albany, NY 12208. Phone: (518) 462-3311, ext. 3080. Fax: (518) 462-3350. E-mail: Baltch.Aldona{at}Albany.VA.gov.

dagger Present address: TechLab, Inc., Blacksburg, VA 24060.

Journal of Clinical Microbiology, October 1998, p. 2957-2963, Vol. 36, No. 10
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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