Prevalence of Clostridium difficile infections among hospitalized patients in Amman, Jordan: A multi-center study

Abstract

Objective: To evaluate the prevalence of C. difficile infection (CDI) among hospitalized patients with toxin-positive stools. Methods: This study is a multicenter study held in Jordan and focused on the prevalence of in-patients with C. difficile toxin-positive diarrhea- stools. The study included three hospitals with approximately 750 beds. In-patients charts, laboratory logbooks for in-patients with diarrhea-stool specimens were reviewed. The participating hospitals used a rapid test, which detects fecal C. difficile toxins A and B. Results: 174 stool specimens were reviewed from March 2013 to October 2014, and 170 stool specimens from 168 patients were evaluated. The patients included 102 (60%) males, and 66 (40%) females including seven (10.6%) peripartum females. The patients were classified in the following age groups:neonates ≤ 28 days, infants 29 days - less than one year old (n = 4, 2.4%), 1 – 4 years (n = 3, 1.8%), and arbitrarily: 5 - 9 years (n = 3, 1.8%), 10 – 14 years (n = 3, 1.8%), 15 – 40 years (n = 33, 19.4%), 41- 64 years, (n = 53, 31.2%) and ≥ 65 years were (n = 71, 41.8%).Adults and older age groups make up the majority of all patients (92.4%). Comorbidities were highly prevalent among the patients: diabetic (n = 71, 41.8%), chronic lung diseases (n = 25, 14.7%), solid tumors other than colonic tumors (n = 12, 7.1%), immune-suppressive state (n = 15, 8.8%), and one patient had colonic tumor. The majority of the patients (n = 21) were on more than one class of broad-spectrum antimicrobials. The prevalence of C. difficile toxin-positive stools were 14.63/1000 discharged patients, 12.65% of patients (12.96% of stool specimens) and 5.0/1000 patient-day. The age-adjusted CDI distribution showed that the rates increased with age and were relatively low in the neonatal period. Conclusion: The hospital-associated C. difficile prevalence showed high rates, particularly in adults and older patients, in patients with a prolonged hospital stay, and comorbidities.