Clostridium difficile in Antibiotic-Associated Diarrhoea and Detection of Toxin Producing Strains in a Tertiary Care Hospital in Western Maharashtra

Abstract

Background: Rampant and injudicious use of broad spectrum antibiotic in hospitalized patients has increased the incidence of Clostridium difficile Associated Diarrhea (CDAD). In recent years, Clostridium difficile Infection (CDI) has become more frequent, severe, and difficult to treat. Aim and Objective: A prospective, study was conducted to isolate C. difficile in Antibiotic-associated Diarrhoea (AAD) and to detect toxin producing strains of C. difficile from faecal samples of patients suspected to have CDI. Material and Methods: A total of 111 hospitalized patients who developed diarrhoea after >72 hours of admission and suspected of CDI were enrolled for investigation. The samples were subjected to anaerobic culture and toxin assay. Results: The total sample size of the study was 111 patients who were having antibiotic associated diarrhoea. Majority of the patients were from the age group 21-30 years and 41-50 years i.e., 23 (20.7%). Males 64 (57.7%) were affected more as compared to females 47 (42.3%). Third generation cephalosporins were the most common group of antibiotics associated with both AAD 36 (32.4%) and CDAD 9 (42.85%) cases, followed by carbapenem fluroquinolones in combination 3 (12.5%). Culture positivity was seen in 12 (10.81%) of the 111 stool samples and 39 (35.13%) were toxin producers. Conclusion: The use of several medications was found to be associated with an increased risk of CDAD. The only way to reduce Cl. difficile infection is to judiciously use antibiotics, strictly adhere to antibiotic policy and to give prime importance to strict infection control measures.

Keywords

• Clostridium difficile
• Clostridium difficile Associated Diarrhea
• Antibiotic-associated Diarrhoea