Antibiotic associated diarrhea due to Clostridioides difficile in a tertiary care teaching hospital, central India
Abstract
Background and Objectives: The misuse of antibiotics in recent years has led to an increase in antibiotic associated diarrheas (AAD). Out of several implicated pathogens, Clostridioides difficile is responsible for causing 15-25% of all cases of AAD. However, it has remained under diagnosed for a long time. The current study is planned to explore prevalence of C. difficile amongst AAD patients and to study clinical presentation and associated risk factors.
Materials and Methods: Hospital based cross sectional study conducted in patients above 2 years of age. Diagnosis of C. difficile was done by two modalities i.e. glutamate dehydrogenase test followed by toxin detection using enzyme immunoassay and stool culture followed by toxin gene detection.
Results: Twelve of 65 patients (18.4%) were positive for C. difficile. Maximum cases were found in younger age group. Abdominal pain and fever were most common complaints. 12 (18.4%) out of 65 study subjects were found to be positive by ELISA. 2/65 (3%) patients were positive for culture with presence of only tcdB gene. Ceftriaxone was the most commonly used antibiotic (25%).
Conclusion: C. difficile is significant pathogen implicated in AAD with a prevalence rate of 18.4%. GDH antigen detection followed by Toxin A/B ELISA for C. difficile yielded better detection rate as compared to stool culture.
2. The Lancet Infectious Diseases. C. difficile-a rose by any other name. Lancet Infect Dis 2019; 19: 449.
3. Barbut F, Petit JC. Epidemiology of Clostridium difficile-associated infections. Clin Microbiol Infect 2001; 7: 405-410.
4. Depestel DD, Aronoff DM. Epidemiology of Clostridium difficile infection. J Pharm Pract 2013; 26: 464-475.
5. Kadri SS. Key Takeaways from the U.S. CDC’s 2019 antibiotic resistance Threats report for frontline providers. Crit Care Med 2020; 48: 939-945.
6. Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American college of gastroenterology, practice parameters committee. Am J Gastroenterol 1997; 92: 739-750.
7. Neemann K, Freifeld A. Clostridium difficile-associated diarrhea in the oncology patient. J Oncol Pract 2017; 13: 25-30.
8. Crobach MJT, Planche T, Eckert C, Barbut F, Terveer EM, Dekkers OM, et al. European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection. Clin Microbiol Infect 2016; 22 Suppl 4: S63-81.
9. Kato N, Ou CY, Kato H, Bartley SL, Brown VK, Dowell VR, et al. Identification of toxigenic Clostridium difficile by the polymerase chain reaction. J Clin Microbiol 1991; 29: 33-37.
10. Chaudhry R, Joshy L, Kumar L, Dhawan B. Changing pattern of Clostridium difficile associated diarrhoea in a tertiary care hospital: a 5 year retrospective study. Indian J Med Res 2008; 127: 377-382.
11. Monaghan TM, Biswas R, Sattav A, Ambalkar S, Kashyap RS. Clostridioides difficile epidemiology in India. Anaerobe 2022; 74: 102517.
12. Segar L, Easow JM, Srirangaraj S, Hanifah M, Joseph NM, Seetha KS. Prevalence of Clostridium difficile infection among the patients attending a tertiary care teaching hospital. Indian J Pathol Microbiol 2017; 60: 221-225.
13. Ingle M, Deshmukh A, Desai D, Abraham P, Joshi A, Rodrigues C, et al. Prevalence and clinical course of Clostridium difficile infection in a tertiary-care hospital: a retrospective analysis. Indian J Gastroenterol 2011; 30: 89-93.
14. Chaudhry R, Sharma N, Gupta N, Kant K, Bahadur T, Shende TM, et al. Nagging presence of Clostridium difficile associated diarrhoea in North India. J Clin Diagn Res 2017; 11: DC06-DC09.
15. Rodríguez-Varón A, Muñoz OM, Pulido-Arenas J, Amado SB, Tobón-Trujillo M. Antibiotic-associated diarrhea: Clinical characteristics and the presence of Clostridium difficile. Rev Gastroenterol Mex 2017; 82: 129-133.
16. Elgendy SG, Aly SA, Fathy R, Deaf EAE, Abu Faddan NH, Abdel Hameed MR. Clinical and microbial characterization of toxigenic Clostridium difficile isolated from antibiotic associated diarrhea in Egypt. Iran J Microbiol 2020; 12: 296-304.
17. Ghia CJ, Waghela S, Rambhad GS. Systematic literature review on burden of Clostridioides difficile infection in India. Clin Pathol 2021; 14: 2632010X211013816.
18. Peterson LR, Kelly PJ, Nordbrock HA. Role of culture and toxin detection in laboratory testing for diagnosis of Clostridium difficile-associated diarrhea. Eur J Clin Microbiol Infect Dis 1996; 15: 330-336.
19. Mirzaei EZ, Rajabnia M, Sadeghi F, Ferdosi-Shahandashti E, Sadeghi-Haddad-Zavareh M, Khafri S, et al. Diagnosis of Clostridium difficile infection by toxigenic culture and PCR assay. Iran J Microbiol 2018; 10: 287-293.
20. Edwards AN, Suarez JM, McBride SM. Culturing and maintaining Clostridium difficile in an anaerobic environment. J Vis Exp 2013; 79: e50787.
21. Predrag S, Branislava K, Miodrag S, Biljana M– S, Suzana T, Natasa M– T, et al. Clinical importance and representation of toxigenic and non-toxigenic Clostridium difficile cultivated from stool samples of hospitalized patients. Braz J Microbiol 2012; 43: 215-223.
22. Bulusu M, Narayan S, Shetler K, Triadafilopoulos G. Leukocytosis as a harbinger and surrogate marker of Clostridium difficile infection in hospitalized patients with diarrhea. Am J Gastroenterol 2000; 95: 3137-3141.
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Issue | Vol 15 No 1 (2023) | |
Section | Original Article(s) | |
DOI | https://doi.org/10.18502/ijm.v15i1.11918 | |
Keywords | ||
Clostridioides difficile; Diarrhea; Antibiotics |
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