Euroasian journal of hepato-gastroenterology

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VOLUME 14 , ISSUE 1 ( January-June, 2024 ) > List of Articles

Original Article

Healthcare-associated Diarrhea due to Clostridioides difficile in Patients Attending a Tertiary Care Teaching Hospital of North India

Nikhil Raj, Jyotsna Agarwal, Vikramjeet Singh, Manodeep Sen, Anupam Das

Keywords : Clostridioides difficile, Diarrhea, Healthcare-associated infection, Glutamate dehydrogenase

Citation Information : Raj N, Agarwal J, Singh V, Sen M, Das A. Healthcare-associated Diarrhea due to Clostridioides difficile in Patients Attending a Tertiary Care Teaching Hospital of North India. Euroasian J Hepatogastroenterol 2024; 14 (1):60-64.

DOI: 10.5005/jp-journals-10018-1429

License: CC BY-NC 4.0

Published Online: 12-06-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Background: Healthcare-associated diarrhea (HCAD) is diarrhea that develops at least after 3 days of hospitalization, with the most common infectious cause being Clostridioides difficile. Over the last decade, there has been a remarkable growth in the frequency and severity of C. difficile infection (CDI), making it one of the most prevalent healthcare-associated infections. This study aimed to analyze the prevalence and risk factors associated with CDI. Materials and methods: A total of 107 patients with clinical suspicion of having HCAD were included in this study. Enzyme-linked fluorescent assay (ELFA) technique-based glutamate dehydrogenase (GDH) and toxin A/B assay were used as per the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) for diagnosing CDI. The details about associated comorbidities were retrieved from the hospital information system records. The presence of risk factors was noted. Risk factors associated with CDI were looked for. Results: Out of the 107 stool samples received in the microbiology laboratory from patients with suspected HCAD eight (7.6%) samples were positive for CDI. The most frequent comorbidity observed in these patients was renal illness (acute or chronic kidney disease). In this study, a total of 7/8 cases were on multiple antibiotics most common being carbapenem. Conclusion: The 6-year prevalence of CDI observed in this study was found to be 7.6% risk factors, associated with CDI were kidney disease, diabetes mellitus, malignancy, and exposure to broad-spectrum antibiotics.

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  1. Turner NA, Saullo JL, Polage CR. Healthcare associated diarrhea, not Clostridioides difficile. Curr Opin Infect Dis. 2020;33(4):319–326. DOI: 10.1097/QCO.0000000000000653.
  2. World Health Organization. Diarrhoeal disease. Available at: Accessed date: 10 March 2024.
  3. Polage CR, Solnick JV, Cohen SH. Nosocomial diarrhea: Evaluation and treatment of causes other than Clostridium difficile. Clin Infect Dis 2012;55(7):982–989. DOI: 10.1093/cid/cis551.
  4. Edwards AN, Suárez JM, McBride SM. Culturing and maintaining Clostridium difficile in an anaerobic environment. J Vis Exp 2013;14(79):e50787. DOI: 10.3791/50787.
  5. Depestel DD, Aronoff DM. Epidemiology of Clostridium difficile infection. J Pharm Pract 2013;26(5):464–475. DOI: 10.1177/08971 90013499521.
  6. Eze P, Balsells E, Kyaw MH, et al. Risk factors for Clostridium difficile infections: An overview of the evidence base and challenges in data synthesis. J Glob Health 2017;7(1):010417. DOI: 10.7189/jogh.07.010417.
  7. Czepiel J, Dróżdż M, Pituch H, et al. Clostridium difficile infection: Review. Eur J Clin Microbiol Infect Dis. 2019;38(7):1211–1221. DOI: 10.1007/s10096-019-03539-6.
  8. Crobach MJT, Vernon JJ, Loo VG, et al. Understanding Clostridium difficile colonization. Clin Microbiol Rev 2018;31(2):e00021-17. DOI: 10.1128/CMR.00021-17.
  9. Mullish BH, Williams HR. Clostridium difficile infection and antibiotic-associated diarrhoea. Clin Med (Lond) 2018;18(3):237–241. DOI: 10.7861/clinmedicine.18-3-237.
  10. Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med. 2015;372(16):1539–1548. DOI: 10.1056/NEJMra1403772.
  11. Hensgens MPM, Goorhuis A, Dekkers OM, et al. Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. J Antimicrob Chemother 2012;67(3):742–748. DOI: 10.1093/jac/dkr508.
  12. Biswas R, Dudani H, Lakhera P, et al. Challenges and future solutions for detection of Clostridioides difficile in adults. Ann Gastroenterol 2023;36(4):369–377. DOI: 10.20524/aog.2023.0802.
  13. Cheng JW, Xiao M, Kudinha T, et al. The role of glutamate dehydrogenase (GDH) testing assay in the diagnosis of Clostridium difficile infections: A high sensitive screening test and an essential step in the proposed laboratory diagnosis workflow for developing countries like China. PLoS One 2015;10(12):e0144604. DOI: 10.1371/journal.pone.0144604.
  14. Crobach MJ, Dekkers OM, Wilcox MH, et al. European Society of Clinical Microbiology and Infectious Diseases (ESCMID): Data review and recommendations for diagnosing Clostridium difficile-infection (CDI). Clin Microbiol Infect 2009;15(12):1053–1066. DOI: 10.1111/j.1469-0691.2009.03098.x.
  15. Novak–Weekley SM, Marlowe EM, Miller JM, et al. Clostridium difficile testing in the clinical laboratory by use of multiple testing algorithms. J Clin Microbiol 2010;48(3):889–893. DOI: 10.1128/JCM.01801-09.
  16. Biswas R, Pinkham N, Walk ST, et al. The molecular epidemiology of Clostridioides difficile infection in central India: A prospective observational cohort study. Microbiol Res 2023;14(3):1279–1290. DOI: 10.3390/microbiolres14030086.
  17. Monaghan, T, Biswas R, Satav A, et al. Prevalence of Clostridioides difficile infection in central India: A prospective observational cohort study. Gut 2021;70(Suppl 4):A1–A220. DOI: 10.1136/gutjnl-2021-BSG.293.
  18. Justin S, Antony B. Clinico–microbiological analysis of toxigenic Clostridium difficile from hospitalised patients in a tertiary care hospital, Mangalore, Karnataka, India. Indian J Med Microbiol 2019;37(2):186–191. DOI: 10.4103/ijmm.IJMM_17_357.
  19. Vaishnavi C, Gupta PK, Sharma M, et al. Pancreatic disease patients are at higher risk for Clostridium difficile infection compared to those with other co-morbidities. Gut Pathog 2019;11:17. DOI: 10.1186/s13099-019-0300-2.
  20. Singhal T, Shah S, Tejam R, et al. Incidence, epidemiology and control of Clostridium difficile infection in a tertiary care private hospital in India. Indian J Med Microbiol 2018;36(3):381–384. DOI: 10.4103/ijmm.IJMM_18_340.
  21. Sachu A, Dinesh K, Siyad I, et al. A prospective cross sectional study of detection of Clostridium difficile toxin in patients with antibiotic associated diarrhoea. Iran J Microbiol 2018;10(1):1–6. PMID: 2992 2412.
  22. Chaudhry R, Sharma N, Gupta N, et al. Nagging presence of Clostridium difficile associated diarrhoea in North India. J Clin Diagn Res 2017;11(9):DC06–DC09. DOI: 10.7860/JCDR/2017/29096.10592.
  23. Kumar N, Ekka M, Ranjan S, et al. Clostridium difficile infections in HIV-positive patients with diarrhoea. Natl Med J India 2014;27(3):138–140. PMID: 25668083.
  24. Garey KW, Graham G, Gerard L, et al. Prevalence of diarrhea at a university hospital and association with modifiable risk factors. Ann Pharmacother 2006;40(6):1030–1034. DOI: 10.1345/aph.1H028.
  25. Asha NJ, Tompkins D, Wilcox MH. Comparative analysis of prevalence, risk factors, and molecular epidemiology of antibiotic-associated diarrhea due to Clostridium difficile, Clostridium perfringens, and Staphylococcus aureus. J Clin Microbiol 2006;44(8):2785–2791. DOI: 10.1128/JCM.00165-06.
  26. Curcio D, Cané A, Fernández FA, et al. Clostridium difficile-associated diarrhea in developing countries: A systematic review and meta-analysis. Infect Dis Ther 2019;8(1):87–103. DOI: 10.1007/s40121-019-0231-8.
  27. Monaghan T, Biswas R, Ambalkar S, et al. PTH-91 Multiplex PCR for determining aetiology of infectious diarrhoea in rural and urban Central Indian populations Gut 2021;70(Suppl. 4):A158–A159. DOI: 10.1136/gutjnl-2021-BSG.294.
  28. Abuderman AA, Mateen A, Syed R, et al. Molecular characterization of Clostridium difficile isolated from carriage and association of its pathogenicity to prevalent toxic genes. Microb Pathog 2018;120:1–7. DOI: 10.1016/j.micpath.2018.04.013.
  29. Kannambath R, Biswas R, Mandal J, et al. Clostridioides difficile Diarrhea: An Emerging Problem in a South Indian Tertiary Care Hospital. J Lab Physicians. 2021;13:346–52.
  30. Ingle M, Deshmukh A, Desai D, et al. Prevalence and clinical course of Clostridium difficile infection in a tertiary-care hospital: A retrospective analysis. Indian J Gastroenterol Off J Indian Soc Gastroenterol 2011;30(2):89–93. DOI: 10.1007/s12664-011- 0097-5.
  31. Tleyjeh IM, Bin Abdulhak AA, Riaz M, et al. Association between proton pump inhibitor therapy and Clostridium difficile infection: A contemporary systematic review and meta-analysis. PloS One 2012;7(12):e50836. DOI: 10.1371/journal.pone.0050836.
  32. Kim SC, Seo MY, Lee JY, et al. Advanced chronic kidney disease: A strong risk factor for Clostridium difficile infection. Korean J Intern Med. 2016;31(1):125–133. DOI: 10.3904/kjim.2016.31.1.125.
  33. Eliakim–Raz N, Fishman G, Yahav D, et al. Predicting Clostridium difficile infection in diabetic patients and the effect of metformin therapy: A retrospective, case–control study. Eur J Clin Microbiol Infect Dis 2015;34(6):1201–1205. DOI: 10.1007/s10096-015- 2348-3.
  34. Hota SS, Achonu C, Crowcroft NS, et al. Determining mortality rates attributable to Clostridium difficile infection. Emerg Infect Dis 2012;18:305–307. DOI: 10.3201/eid1802.101611.
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