Clinical and microbial characterization of toxigenic Clostridium difficile isolated from antibiotic associated diarrhea in Egypt

Antimicrobial Resistance and Associated Risk Factors for Clostridium difficile in Patients Attending Tertiary Care Settings

To determine the incidence of antimicrobial-resistant emerging pathogens, Clostridium difficile, and its associated risk factors in tertiary care setups of Pakistan. This cross-sectional prospective study was conducted from January 2019 to December 2020, to determine the prevalence and antimicrobial resistance patterns of C. difficile strains isolated from 450 stool specimens of patients suffering from diarrhea hospitalized in tertiary care hospitals in Peshawar, Pakistan. The stool samples of the patients were processed for culture and detection of toxin A and toxin B by enzyme-linked immunosorbent assay (ELISA) and tpi PCR. The drug sensitivity test was performed for antibiotics including ampicillin, cefixime, cefepime, amoxicillin, nalidixic acid, sulpha/TMP (SXT), chloramphenicol, metronidazole, vancomycin, ciprofloxacin, levofloxacin, and imipenem. Of 450 stool specimens, 108 (24%) were positive for C. difficile by stool culture, whereas 115 (25.5%) were only positive for C. difficile toxins based on ELISA and PCR (128 (28.6%). Of 108, 90.7% (n = 98) isolates were resistant to one antibiotic, and 90 (83.4%) were resistant to three or more antimicrobials. The highest resistance rates were found against penicillin (83.3%) followed by amoxicillin (70%), nalidixic acid (61%), and metronidazole (38%), and the lowest resistance was found against vancomycin (6.4%) and imipenem (3.7%). CDI was statistically significantly correlated with increased age, use of antibiotics, abdominal surgeries, use of proton pump inhibitors and H2a, and presence of comorbidities. The high frequency of C. difficile in Peshawar, Pakistan, indicates that CDI is an important nosocomial infection in different hospitals. The results will be helpful for clinicians to redesign control and therapeutic strategies in hospitals.

Characteristics, Risk Factors, and Prevalence of Clostridioides difficile Among Hospitalized Patients in a Tertiary Care Hospital in Palestine

PURPOSE

Clostridioides difficile is one of the most important nosocomial infection pathogens. It is linked with many risk factors. Unfortunately, many studies have been conducted in different countries to address the Clostridioides difficile infections (CDI), and no studies have been conducted in Palestine. This study aims to identify the prevalence and possible risk factors associated with CDI.

PATIENTS AND METHODS

This was a retrospective descriptive study conducted at the An-Najah National University Hospital (NNUH) in Palestine. Data were collected for patients diagnosed with CDI who tested positive for GDH, toxins A and B between January 2018 and April 30, 2021. In addition, patient characteristics and risk factors associated with CDI were analyzed.

RESULTS

A total of 593 participants were included in the study; 53% had hospital-acquired CDI. There was an insignificant association between participant age and CDI risk. Most patients had mild to moderate infections. Sixty-three percent of the participants were immunocompromised. About 58.5% used an antibiotic agent two weeks before CDI, and 67% were on a proton pump inhibitor (PPI). About 61.3% of patients were treated according to IDSA 2017 guidelines, and 94% responded adequately to the treatment provided.

CONCLUSION

There was an increased prevalence of community-acquired CDI, with a prevalence almost equal to that of hospital-acquired. In addition, most of the participants were immunocompromised. The risk factors for CDI, such as antibiotics and PPI use, were also observed with high prevalence among positive patients. Antimicrobial stewardship and the appropriate use of acid suppressors are warranted.