Backround & Objective: Clostridium difficile associated disease (CDAD) is a matter of grave concern in the hospital environments due to antimicrobial usage.
Methods: We investigated the clinical and demographic profile of patients whose fecal sampleswere received in our laboratory and correlated the same with their C. difficile toxin (CDT) status. Six hundred twenty nine consecutive and non-repeat fecal samples were subjected to CDT assay using purified anti-toxin A and anti-toxin B coated to latex beads. Semi-quantitative titrations were carried out with the positive samples with a doubling dilution method. Clinical and demographic profile of each patient was recorded. During analysis the patients were assigned to two groups (i) Group 1 comprised of those receiving antibiotics and/or other drugs and (ii) Group 2 of those not receiving any drug.
Results: The age of the patients ranged froma few days to 93 years. Predominant clinical symptoms were diarrhoea (98.7%), abdominal pain (35.9%) and fever (49.8%). CDT was positive in 45.8%with titers ranging from 1 in 5 to 1 in 2560. CDT positivity was highly influenced by prior antibiotic and drug intake (p<0.05). Fever was present in 43.4%and abdominal pain in 35.5%of CDT positive cases. CDT positivitywas also significantly associated with age below 2 years (p<0.001) and between 41-55 years (p<0.01). CDT positivitywas highly associated with gastrointestinal diseases (32.5%) and age.
Interpretation & conclusion: Readily available clinical and basic laboratory data are useful for correlation with severity of CDAD.
Hopkins MJ, Mac Farlane GT. Changes in predominant bacterial populations in human faeces with age and with Clostridium difficile infection. J Med Microbiol 2002;51(5):448-54.
Blondeau, JM. What have we learned about antimicrobial useand the risks for Clostridium difficile-associated diarrhea? J Antimicrob Chemother 2009;63(2):238-42.
Kaur S, Vaishnavi C, Prasad KK, Ray P, Kochhar R. Comparative role of antibiotic and proton pump inhibitor in experimental Clostridium difficile infection in mice. Microbiol Immunol 2007;51(12):1209-14.
Kaur S, Vaishnavi C, Ray P, Kochhar R, Prasad KK. Effect of biotherapeutics on cyclosporin-induced Clostridium difficile infection in mice. J Gastroenterol Hepatol 2010;25(4):832-8.
Emoto M, Kawarabayashi T, Hachisuga T, Eguchi F, Shirakawa K. Clostridium difficile colitis associated with cisplatin-based chemotherapy in ovarian cancer patients. Gynecol Oncol 1996;61(3):369-72.
Kumar B, Vaishnavi C, Sandhu K, Kaur I. Clostridium difficile toxin assay in psoriatic patients. Trop Gastroenterol 2004;25(4):164-7.
Cherifi S, Delmee M, Broeck JV, Beyer I, Byl B, Mascart G. Management of an outbreak of C. difficile-associated disease among geriatric patients. Infect Control Hosp Epidemiol 2006;27(11):1200-5.
Bartlett JG. Historical perspectives on studies of Clostridium difficile and C. difficile infection Clin Infect Dis 2008;46 Suppl 1:S4-11.
Lima AA, Lyerly DM, Wilkins TD, Innes DJ, Guerrant RL. Effects of Clostridiumdifficile toxins Aand B in rabbit small and large intestine in vivo and on cultured cells in vitro. Infect Immun 1988;56(3):582-8.
Lyerly DM, Saum KE, Mac Donald DK, Wilkins TD. Effect of Clostridiumdifficile toxins given intragastrically to animals. Infect Immun 1985;47(2):349-52.
Poxton IR, Mc Coubrey JM, Blair G. The pathogenicity of Clostridium difficile. Clin Microbiol Infect. 2001;7(8):421-7.
Vaishnavi C, Kochhar R, Bhasin DK, Thapa BR, Singh K. Detection of Clostridium difficile toxin by an indigenously developed latex agglutination assay. Trop Gastroenterol. 1999;20:33(1)-5.
Heard SR, O'Farrell S, Holland D, Crook S, Barnett MJ, Tabaqchali S. The epidemiology of Clostridiumdifficilewith use of typing scheme: nosocomial acquisition and cross-infection among immunocompromised patients J Infect Dis. 1986;153:159-62.
Kaatz GW, Gitlin SD, Schaberg DR, Wilson KH, Kauffman CA, Seo SM et al. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988;127:1289-94.
Pillai A, Nelson RL. Probiotics for treatment of Clostridium difficile-associated colitis in adults. Cochrane Database Syst Rev 2008;23(1):CD004611.
Dhawan B, Chaudhry R. An update on Clostridium difficile infection. Trop. Gastroenterol 1997;18(4):149-52.
Poutanen SM, Simor AE. Clostridium difficile-associated diarrhea in adults. Can Med Assoc J 2004;171(1):51-8.
Nelson RL, Kelsey P, Leeman H, Meardon N, Patel H, Paul K, et al.. Antibiotic treatment for Clostridium difficile-associated diarrhea in adults. Cochrane Database Syst Rev 2011;(9):CD004610.
Wilson KH. Themicroecology of Clostridiumdifficile. Clin Infect Dis. 1993; 16: S214-8.
Akerlund T, Svenungsson B, Lagergren A, Burman LG. Correlation of disease severitywith fecal toxin levels in patients with Clostridium difficile-associated diarrhea and distribution of PCR ribotypes and toxin yields in vitro of corresponding isolates. J Clin Microbiol. 2006;44:353-8.
Mc Donald LC, Killgore G, Thompson A, Owens RC Jr, Kazakova SV, Sambol SP et al. An epidemic, toxin gene-variant strain of Clostridiumdifficile. NEngl J Med. 2005;353(23):2433- 41.
Henrich TJ, Krakower D, Bitton A, Yokoe DS. Clinical risk factors for severe Clostridiumdifficile-associated disease. Emerg Infect Dis. 2009;15(8):415-22.
Das R, Feuerstadt P, Brandt LJ. Glucocorticoids are associated with increased risk of short term mortality in hospitalized patients with Clostridium difficile associated disease. Am J Gastroenterol. 2010; 105(9): 2040-9.
Bajaj JS, Ananthakrishnan AN, Hafezullah M, Zadvornova Y, Dye A, Mc Glinley EL et al. Clostridium difficile is associated with poor outcomes in patients with cirrhosis: A national and tertiary center perspective. Am J Gastroenterol. 2010;105(1):106-13.
Halvorson SA, Cedfeldt AS, Hunter AJ. Fulminant non-antibiotic associated Clostridium difficile colitis following Salmonella gastroenteritis. J. Gen. Intern Med. 2011; 26(1): 95-7.
Dubberke ER, Reske KA, Olsen MA, Mc Donald LC, Fraser VJ. Short and long termattributable cost of Clostridiumdifficile– associated disease in non-surgical patients. Clin Infect Dis. 2008;46(4): 497-504.
Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. Am J Gastroenterol. 1997;92(5):739-50.
Pinto LJF, Alcides APP, Ferreira EO, Avelar KES, Sabra A, Domingues RMCP et al. Incidence and importance of Clostridium difficile in paediatric diarrhea in Brazil. J Med Microbiol 2003;52:1095-9.