Antibiotic associated diarrhea due to Clostridioides difficile in a tertiary care teaching hospital, central India

Sunandini Kapoor; Shashwati Nema; Debasis Biswas; Sagar Khadanga; Saurabh Saigal; Mahesh Maheshwari

doi:10.18502/ijm.v15i1.11918

Sunandini Kapoor Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
Shashwati Nema Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
Debasis Biswas Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
Sagar Khadanga Department of General Medicine, All India Institute of Medical Sciences, Bhopal, India
Saurabh Saigal Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, India
Mahesh Maheshwari Department of Pediatrics, All India Institute of Medical Sciences, Bhopal, India

DOI: https://doi.org/10.18502/ijm.v15i1.11918

Keywords: Clostridioides difficile; Diarrhea; Antibiotics

Abstract

Background and Objectives: The misuse of antibiotics in recent years has led to an increase in antibiotic associated diar- rheas (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 immunoas- say 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.