Detection of Clostridium difficile infection in patients with antibiotic associated diarrhea in a tertiary care hospital

Background-Clostridium difficile is a major cause of hospital acquired diarrhea and is responsible for psuedomembranous colitis. Aims and objectives1]To isolate C.difficile from stool samples of patients,on long term antibiotics, admitted in the hospital 2] to detect the toxin production by ELISA. Material and Methods-A total of 50 stool specimens were processed for culture and for detection of C. difficile toxin A and toxin B via C.difficile A+B Stool Antigen Elisa kit from patients on long term antibiotics for a period of 8 months. All C.difficile suspected cases were from Medicine ward and were on multiple antibiotics for more than 7 days. KeywordsC.difficile, AAD, C.difficile toxin A+B IntroductionDiarrhea is one of the most common complications associated with antibiotic therapy (1) . C.difficile is a primary pathogen responsible for 15-25% cases of nosocomial Antibiotic associated Diarrhea (AAD )(2) . The risk of C.difficile acquisition increases in proportion to the length of the hospital stay. C.difficile produces both an enterotoxin, toxin A and a cytotoxin B (1) . The prevalence of C.difficile spores in the environment is higher among hospital and thus the patients have higher rate of C.difficile colonization than the healthy adults in the general population. Prolonged hospital stay, elderly age, immunosuppressive conditions have been recognized as risk factors for C.difficile infection [CDI ](2,3) . Elderly patients are at higher risk of acquiring disease rate for patients as much as 20 fold higher than those for younger patients (2) . Other factors that increase the vulnerability include underlying disease severity, non surgical gastrointestinal procedures, use of antiulcer medications. Also the patients who have suppressed immune response to C.difficile toxins are at increased risk (1,2) .Further antibiotic therapy causes imbalance of intestinal tract bacterial flora, which predisposes C.difficile proliferation and colonization of intestinal tract mucosa (4) . The toxigenic C.difficile may excrete exotoxins, enterotoxin (toxin A) and cytotoxin (toxin B) and both can cause diarrhea and colitis. Toxin B being major virulence factor according to recent studies (1) . Indian Journal of Basic and Applied Medical Research; December 2016: Vol.-6, Issue1, P. 143-147 144 www.ijbamr.com P ISSN: 2250-284X , E ISSN : 2250-2858 C.difficile associated diarrhea (CDAD) covers a wide range of diseases from asymptomatic to mild diarrhea to moderately severe diarrhea and pseudomembranous colitis which can be fatal (4) . Frequent indiscriminate use of broad spectrum antibiotics has increased the incidence of C.difficile associated diarrhea in the recent years (1) . CDAD is the most common cause of antibiotic associated diarrhea responsible for one third of AAD cases, 5070% for antibiotic associated coliltis and 90-100% cases of pseudomembranous colitis which is the most severe manifestation of CDAD (1,2) . CDAD is one of the commonest causes of nosocomial diarrhea (1) .Clindamycins, Penicillins and Cephalosporins and Fluroquinolones are frequently used antibiotics (1,2) .The prevalence of CDAD is global and the incidence varies from place to place. However CDAD is still under diagnosed in India and Asia (2) .Present study was undertaken to detect the presence of C.difficile and/or the toxin produced from the stool sample of patients on long term antibiotic. The presence of organism and/or toxin can initiate precise and effective antibiotic therapy. Also it will help to undertake infection control measures in the hospital. Aims and Objectives• To isolate the C.difficile from stool samples of patients on long term antibiotics admitted in hospital. • To detect the toxin production by ELISA. Materials and MethodsA prospective study was conducted on 50 patients presenting with diarrhea who were on antibiotic therapy. Other etiologies of diarrhea were ruled out by microscopy and culture. 1) Inclusion criteria-Patients on antibiotics for more than 5 days and with diarrhea. 2) Exclusion criteria• Patients without antibiotics or on antibiotic less than 5 days. • Patients with other known cause of diarrhea. • Patients suffering from TB and