Nosocomial diarrhea caused by Clostridium perfringens in the Tsukuba-Tsuchiura district, Japan

We examined the incidence of nosocomial diarrhea caused by Clostridium perfringens enterotoxin (CPEnt) in three tertiary hospitals in the Tsukuba-Tsuchiura district, Japan. In addition, isolated strains were genomically characterized. Among 294 stool specimens submitted for C. difficile toxin A (CDTxA) assay during a period of 6 months, 6 (0.42 cases per 1000 beds monthly) and 79 (5.5) were positive for CPEnt and CDTxA, respectively. C. perfringens with the cpe gene was detected in 15 (5%) of the specimens. Genomically indistinguishable strains were isolated from one pair of specimens submitted from one hospital, and from three submitted from different hospitals. Four specimens submitted from one hospital contained C. perfringens with the cpe and the cpb2 genes. We concluded that C. perfringens caused nosocomial diarrhea one-tenth as frequently as C. difficile did in this district, and that strains causing nosocomial diarrhea might have already been acquired in the community.