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

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.