Clostridium difficile infection rates and spectrum of disease among peripartum women at one hospital from 2003 to 2007 with molecular typing analysis of recovered Clostridium difficile isolates

BackgroundPeripartum women are at risk for Clostridium difficile infection (CDI), but the risk magnitude and clinical disease spectrum are unknown. We determined the incidence and clinical features of CDI in peripartum women in the Loyola University Medical Center system and describe typing of C difficile isolates by restriction endonuclease analysis (REA).MethodsA retrospective chart review of peripartum CDI from 2003 to 2007 was performed after identifying patients from the clinical laboratory log of positive C difficile toxin assays. Available stool samples were cultured and isolates typed using REA.ResultsWe found 12 CDI cases over 5 years for an incidence of 0.7 cases/1,000 obstetrics ward admissions. Prior antibiotic use was documented in 11 (92%) cases, and 8 (67%) were health care facility associated. The rate of CDI following cesarean section was 2.2 per 1,000 live births compared with 0.2 per 1,000 following vaginal delivery (relative risk, 11.6; 95% confidence interval: 1.39-96.23). Typing revealed 4 different REA strain groups; 6 of the 7 REA types were toxin variants.ConclusionCDI in peripartum women is similar to CDI in other groups except for age. CDI was caused by multiple REA types. Cesarean section may be a particular risk for CDI that develops in the postpartum period.