Is Clostridium difficile endemic in chronic-care facilities?

Lancet. 1986 Jul 5;2(8497):11-3. doi: 10.1016/s0140-6736(86)92559-6.


An apparent outbreak of Clostridium difficile diarrhoea on the chronic hospital ward of a long-term care facility prompted an investigation lasting seven months. Approximately a third of patients had stools that were positive for C difficile by either toxin or culture. Attempts to eradicate the infection by simultaneously treating all toxin-positive patients with metronidazole, limiting antibiotic use, and implementing enteric isolation were unsuccessful. New cases were both nosocomially acquired and imported into the facility. Of the C difficile toxin-positive patients, 34% had diarrhoea and 19/49 (38%) died during the study period. C difficile is not routinely sought by most clinical microbiology laboratories and may therefore be endemic in many long-term care facilities for the elderly.

MeSH terms

  • Adult
  • Aged
  • Bacterial Toxins / analysis
  • Clostridium Infections / epidemiology*
  • Clostridium Infections / prevention & control
  • Cross Infection / epidemiology*
  • Diarrhea / epidemiology
  • Diarrhea / prevention & control
  • Disease Outbreaks / epidemiology*
  • Feces / analysis
  • Feces / microbiology
  • Female
  • Hospitals, Chronic Disease*
  • Hospitals, Special*
  • Humans
  • Male
  • Maryland
  • Middle Aged


  • Bacterial Toxins