Clostridium difficile in relation to enteric bacterial pathogens.

All feces samples (n = 2,390) sent to the Bacteriological Laboratory, Göteborg, Sweden over 43 days were, in addition to the standard procedure, cultivated to detect Clostridium difficile by using a special selective medium. C. difficile was found in 81 of the 2,390 samples (3%). These 81 samples represented 56 patients. Fifty of the 56 patients had diarrhea. In 20 of the 56 patients (36%), Salmonella, Campylobacter, or Yersinia were also found. Of the 2,390 samples 252 (11%) from 132 patients revealed positive isolations of Salmonella, Shigella, Campylobacter, or Yersinia in comparison to 3% for C. difficile alone. This result suggests that C. difficile can easily be isolated with proper techniques. Concomitant isolations of more than one bacterial pathogen in cases of gastroenteritis were often found for C. difficile. The theory presented here is that any change of the normal bacterial fecal flora due to such causes as antimicrobial treatment or enteric infections like Salmonella increases the possibilities of isolating C. difficile. The causative significance of C. difficile might in most cases be doubtful. The majority of cases with diarrhea and C. difficile were self-healing and not severe. Only 2 cases of 56 had severe diarrhea with extended engagement of the colonic mucous membrane, but with no signs of pseudomembranes.