Clostridium difficile virulence factors as the cause of antibiotic-associated diarrhea (AAD): a literature review (original) (raw)
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The Indian journal of medical research, 2017
Clostridium difficile is the primary cause of hospital-acquired colitis in patients receiving antibiotics. The pathogenicity of the organism is mainly due to the production of toxins. This study was conducted to investigate the presence of toxigenic C. difficile in the faecal samples of hospitalized patients suspected to have C. difficile infection (CDI) and corroborating the findings with their clinical and demographic data. Diarrhoeic samples obtained from 1110 hospitalized patients were cultured for C. difficile and the isolates confirmed by phenotypic and molecular methods. Toxigenicity of the isolates was determined using enzyme-linked immunosorbent assay for toxins A and B. Details of patients included in the study were noted and analyzed. Of the 1110 patients (mean age 39±19.6 yr), 63.9 per cent were males and 36.1 per cent were females. The major antibiotics received by the patients were nitazoxanide (23.9%), penicillins/penicillin combinations (19.0%), quinolones including ...
Bangladesh Journal of Medical Microbiology, 2018
Clostridium difficile (C. difficile) has become a global public health challenge as C. difficile associated-diarrhea (CDAD) is increasing in incidence and severity of disease in several countries during recent years. This cross sectional study evaluated the frequency of CDAD among 100 adult patients who were clinically diagnosed as nosocomial diarrhoea in various clinical wards of Bangabandhu Shiekh Mujib Medical University (BSMMU) and Dhaka Medical College and Hospital (DMCH). CDAD diagnosis was based on detection of C. difficile along with clinical symptoms of diarrhea. Stool microscopy was done for cytology followed by anaerobic culture in cycloserine cefoxitin fructose agar (CCFA) media, confirmed by latex agglutination of culture isolates. Toxin genes (both A and B) were detected by multiplex Polymerase chain reaction (PCR) from culture isolates. Out of 100 diarrhoeal stool samples collected, 25% samples were pus cell positive in microscopy, culture yielded growth of C. diffici...
The Indian journal of medical research, 2008
Frequent use of broad spectrum antibiotics in hospitalized patients has increased the incidence of Clostridium difficile diarrhoea in recent years. In our tertiary care hospital in north India, C. difficile was responsible for 15 per cent of cases of nosocomial diarrhoea in 1999. A retrospective study was carried out to determine the frequency of C. difficile associated diarrhoea (CdAD) in our hospital, and to assess the effect of awareness among the hospital personnel and control measures taken to present C. difficile infection following the previous report. A retrospective chart review of all suspected cases of CdAD diagnosed at the hospital from January 2001 to December 2005 was done. Clinical specimens comprised 524 stool samples. All the samples were analyzed for C. difficile using culture and ELISA for toxin A and B. Attempts were made to type isolates using antibiogram, SDS-PAGE, gas liquid chromatography (GLC), PCR for toxin A and B gene fragments and restriction fragment le...
Antibiotic-associated diarrhoea and Clostridium difficile> in the community
Alimentary Pharmacology and Therapeutics, 2003
Background: Clostridium difficile is the main cause of nosocomial infectious diarrhoea and the causative agent of antibiotic-associated colitis. The involvement of C. difficile infection in antibiotic-associated diarrhoea in the community is poorly documented. Methods: We studied prospectively 266 adult outpatients in the Paris (France) area who were prescribed a 5-10-day course of antimicrobial chemotherapy. Stools were screened for C. difficile before and 14 days after the start of treatment by standard culture, toxigenic culture and testing for the cytopathic effect of toxin B. Patients were requested to note daily stool frequency and consistency. Diarrhoea was defined as the passage of at least three loose stools per day. Results: Forty-six (17.5%) of the 262 assessable patients had diarrhoea during the study period. Diarrhoea was mild and self-limited in all patients, and lasted for only 1 day in 65.6% of cases. C. difficile was isolated before and after treatment from one patient, who did not develop diarrhoea. C. difficile was detected only on day 14 in 10 patients (3.8%). The isolate was toxin producing in seven patients. Four of these seven patients had mild self-limited diarrhoea. Toxin-producing C. difficile was isolated significantly more frequently from patients who had diarrhoea than from those who were diarrhoea free (8.7% vs. 1.4%, P ¼ 0.02). Conclusion: The acquisition of toxin-producing C. difficile appears to be frequent during antimicrobial chemotherapy in the community [estimated rate of 2700 (1150-5400) cases per 100 000 exposures to antibiotics]. However, C. difficile is not the main agent of mild antibiotic-associated diarrhoea in outpatients .
Annals of Tropical Medicine and Public Health, 2013
Context: Clostridium dif icile is a frequently identi ied cause of nosocomial gastrointestinal disease. It has been proved to be a causative agent in antibiotic-associated diarrhea. Aims: This study was aimed to determine the prevalence and risk factors of Clostridium dif icile-associated diarrhea (CDAD) in hospitalized patients with nosocomial diarrhea in Shiraz, Iran. Materials and Methods: In this study from June to December 2012, a total of 122 stool samples of patients with nosocomial antibiotic associated diarrhea that were admitted in to the intensive care units (ICUs) (41), surgery (16) and organ transplantation wards (65) in Namazi hospital, Shiraz, Iran were collected. All stool samples were cultured on a selective Cycloserine Cefoxitin Fructose Agar and grew isolates were analyzed by cytotoxicity assay and enzyme immune assay for detection and conformation of toxins. Results: The mean ± standard deviation of age was 49.4 ± 13.8 and 75 (61.5%) of patients were male. Nine (7.4%) cases of nosocomial diarrhea were diagnosed as CDAD that all isolates were toxigenic. Five of 65 organs receive transplant patients and 4/41 hospitalized patients in ICUs ward were developed CDAD. None of samples that obtained from surgery ward infected with C. dif icile. Ceftazidime and Ampicilline-Sulbactam were the most common antimicrobial drugs used. Multivariate analysis showed that use of diapers, antibiotic and immunosuppressive therapies were signi icantly associated with CDAD (P < 0.05). Conclusions: Hospital transmission of C. dif icile commonly occurred, supporting infection-appropriate measures directed toward the reduction of CDAD.
American Journal of Infection Control, 2005
Background: Clostridium difficile is a toxin-producing bacterium that is responsible for toxicity to the colonic mucosa, causing inflammation, necrosis, and, in some extreme cases, intestinal dilation and perforation. C difficile-associated diarrhea (CDAD) occurs when patients have a reduction in their natural gastrointestinal flora that allows for the proliferation of and toxin production by C difficile. Methods: Using a multicenter, prospective observational case control study, we assessed and quantified risk factors associated with the development of diarrhea caused by Clostridium difficile, with particular attention to antibiotic use. All hospitalized patients with diarrhea requiring a C difficile toxin test as part of their routine clinical workup were considered for study inclusion. Patients with a negative specimen (controls) were considered for enrollment if matched (by age, sex, length of stay, and institution) to a case. Variables associated with CDAD were identified using univariate analysis. Significant factors were then entered into multivariate logistic regression analysis to identify independent factors. Results: There were no significant differences in antibiotic use between cases and controls. Patient severity, classified by Horn's Index, was significantly different between cases and controls (P 5 .0022). No other significant variables were identified. Conclusion: The severity of illness of the cases was classified as more severe than the controls, but no significant differences in antibiotic use were identified between the groups. The negative C difficile toxin studies on the well-matched control patients indicate a different etiology of diarrhea (such as antibiotic-associated diarrhea), which may have developed in the presence of similar antibiotic use as the cases.
Diagnosis of Clostridium difficile infection in patients with hospital-acquired diarrhea
2018
Clostridium difficile infection (CDI) is a rapidly emerging infection that may have devastating consequences. Prompt and accurate diagnosis is crucial for management and control. The aim of this study was to determine the incidence of C. difficile associated diarrhea among hospitalized patients, and to compare different diagnostic laboratory methods for detection of toxin producing strains in clinical specimens. The study was conducted at a university hospital in Cairo during the period from May 2013 till June 2015. Subjects were under antibiotic therapy and presented with hospital-acquired diarrhea. Four hundred and sixty-five stool specimens were processed by different microbiological methods. C. difficile was recovered in culture in 51 of stool specimens. Of these, 86.3% to 98% were positive for toxin production by 2 different methods. This study showed that antibiotic intake is the major risk factor for development of hospital-acquired diarrhea. We evaluated different microbiological methods for diagnosis of C. difficile. We recommend the use of toxigenic culture as a gold standard for microbiological diagnosis of C. difficile.
Clostridioides difficile Diarrhea: An Emerging Problem in a South Indian Tertiary Care Hospital
Journal of Laboratory Physicians
Context Clostridioides difficile infection (CDI) is one of the most common infectious causes of hospital-acquired diarrhea. The actual burden of the disease is underestimated in India due to inadequate diagnostic methods and limited studies conducted. Aims The aim of this study was to determine the burden and risk factors of CDI among patients with hospital-acquired diarrhea. Methods and Materials Stool specimen of patients (age > 1 year) with hospital-acquired diarrhea were screened for glutamate dehydrogenase antigen and toxin using an enzyme immunoassay. If both antigen and toxin were present, it was reported as positive for toxigenic CDI. Samples positive for antigen and negative for toxin were further tested with Cepheid GeneXpert assay for detecting the toxin producing gene. Results Of 75 patients (mean age 36.07 ± 20.79, 64% males), 14 (18.67%) patients were positive for toxigenic Clostridioides difficile (C. difficile) and 3 (4%) patients were nontoxigenic C. difficile. A...
International Journal of Advanced Research
Context: C. difficile is a major cause of hospital acquired diarrhea. Aims: A prospective study was carried out to determine the prevalence of C. difficile in patients with antibiotic associated diarrhea (AAD) in a tertiary care hospital. Methods and Material: 162 stool samples were examined over a two year period for toxin A and toxin B via C. difficile Toxin A+B Stool Antigen Microwell ELISA kit (IVD Research Inc.). Clinical and demographic data was collected from all patients. Results: The prevalence of C. difficile associated diarrhea was found to be 4.32%. Highest number of C. difficile toxin positive cases was from stool samples of patients admitted in oncology/ hematology followed by internal medicine. Median time of occurrence of symptoms was 7 days after admittance to hospital. All the patients were on multiple antibiotics. Conclusion: This present prospective study draws attention to the role of C. difficile as a cause of AAD in our hospital. Active and aggressive surveill...
2005
Clostridium difficile is a frequently identified cause of nosocomial gastrointestinal disease. It has been proved to be a causative agent in antibiotic-associated diarrhea, antibiotic-associated colitis, and pseudomembraneous colitis. This study was aimed to determine the prevalence of C.difficile-associated diarrhea in hospitalized patients with nosocomial diarrhea. The 942 hospitalized patients stool samples with nosocomial diarrhea were collected at three hospitals in Tehran from Dec 2002 to Feb 2004.All the stool samples were cultured and in 97 (prevalence: 10.9%) samples grew C.difficile that 57 (prevalence: 6.1%) isolates were toxigenic by cytotoxicity assay and so 57 patients had C.difficile-associated diarrhea. Results of statistical analysis showed significant difference between the rate of C.difficile associated diarrhea and the patients ages (P<0.05).