COMPLICATIONS - INFECTIONS

D. Kawecki¹, A. Kwiatkowski², A. Chmura², M. Durlik³, W. Rowinski⁴, M. Luczak¹, G. Mlynarczyk^1
1Medical Microbiology, Medical Unmiversity of Warsaw, Warsaw/POLAND, ²Department Of General Surgery And Transplantology, Medical University of Warsaw, Infant Jesus Clinical Hospital, Warsaw/POLAND, ³Dept Of Transplantation Medicine And Nephrology, Warsaw Medical School, Warsaw/POLAND, ⁴Emeritius, Medical University of Warsaw, Warsaw/POLAND

Body: Objective The frequency of detection of C. difficile (CD) toxins in comparison to recovery of C. difficile in culture from the stool specimens of patients with nosocomial diarrhea in early period after simultaneous pancreas-kidney transplantation (SPKTX). Material and methods The study comprised stool samples (SS) taken from 26 adult simultaneous pancreas-kidney recipients during the first 30 days after SPKTX, suspected of Clostridium difficile-associated diseases. The identification of cultured C. difficile strains was done by standard microbiological methods. The presence of C. difficile toxins was assayed using a commercial immunoassay. The stool specimens were examined for the presence of C. difficile toxin A using a commercial immunoassay Clostridium difficile Toxin A Test® (Oxoid, UK) and enzyme-linked immunosorbent assay TOX A/B TEST® (TechLab, USA) for detection of toxin A and toxin B. The samples were also cultured for C. difficile by inoculation of CCCA ® commercial medium (bioMérieux, France). The plates were incubated at 37ºC for 48 h in an anaerobic chamber “Heraeus” and isolates identified by standard methods for these anaerobic bacteria (colony morphology, characteristic smell of the colonies, microscopic appearance of bacteria and fluorescence in the UV lamp). The identification was confirmed with a latex agglutination assay for C. difficile antigen Culturette Brand CD Test ® (Becton Dickinson, USA). Results All the patients were followed prospectively for CD infections from the SPKTX date and during the first four weeks after surgery. Out of 12 stool samples investigated from 38,5% recipients in the early posttransplant period, 100% have been culture-negative for C. difficile. The testing for CD toxins has been done on 12 samples, yielding 58.3% toxin positive samples and 41.7% toxin and culture negative results. In the first week after SPKTX, SS from 7 (34.6%) patients were obtained for CD investigation. Among 7 samples positive for toxin 42.9% and all samples were culture-negative. From the second week to the end of the first month after SPKTX in 4 (15.4%) recipients 5 SS were analysed. Among these samples positive for toxin 80%, while 20% samples were negative for toxin and culture results. Conclusion In our study 58,3% of SS were toxin positive, 41.7% were negative for toxins and cultures. 100% of stool samples were culture-negative for C.difficile.

Disclosure: All authors have declared no conflicts of interest.