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CC BY-NC-ND 4.0 · J Lab Physicians 2021; 13(04): 346-352
DOI: 10.1055/s-0041-1731944
Original Article

Clostridioides difficile Diarrhea: An Emerging Problem in a South Indian Tertiary Care Hospital

Rachana Kannambath
1   Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
,
Rakhi Biswas
1   Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
,
Jharna Mandal
1   Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
,
Kolar V. Vinod
2   Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
,
Biswajit Dubashi
3   Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
,
Narayanan Parameswaran
4   Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
› Institutsangaben Funding This study was funded by intramural research fund, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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Abstract

Context Clostridioides difficile infection (CDI) is one of the most common infectious causes of hospital-acquired diarrhea. The actual burden of the disease is underestimated in India due to inadequate diagnostic methods and limited studies conducted.

Aims The aim of this study was to determine the burden and risk factors of CDI among patients with hospital-acquired diarrhea.

Methods and Materials Stool specimen of patients (age > 1 year) with hospital-acquired diarrhea were screened for glutamate dehydrogenase antigen and toxin using an enzyme immunoassay. If both antigen and toxin were present, it was reported as positive for toxigenic CDI. Samples positive for antigen and negative for toxin were further tested with Cepheid GeneXpert assay for detecting the toxin producing gene.

Results Of 75 patients (mean age 36.07 ± 20.79, 64% males), 14 (18.67%) patients were positive for toxigenic Clostridioides difficile (C. difficile) and 3 (4%) patients were nontoxigenic C. difficile. Addition of GeneXpert to the testing algorithm increased the yield of toxin detection in 5/14 patients who were negative by toxin assay. On analysis of risk factors, prolonged hospital stay was found to have significant association (p-value = 0.022). Patients with factors like intensive care unit stay, presence of diabetes mellitus as a comorbidity, and exposure to antibiotics like carbapenems and glycopeptides have been found to have a higher prevalence of CDI.

Conclusions The prevalence of CDI in our population was 18.67% and the major risk factor associated was prolonged hospital stay. The addition of GeneXpert for the detection of toxin gene increased the yield from 12 to 18.68%.

Keywords

Clostridioides difficile infection - hospital-acquired diarrhea - toxin detection


Publikationsverlauf

Artikel online veröffentlicht:
09. Juli 2021

© 2021. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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