The Incidence of Nosocomial Toxigenic Clostridium difficile Associated Diarrhea in Tehran Tertiary Medical Centers
-
Norakhoda Sadeghifard
,
Mohammad Hossein Salari
,
Mohammad Raza Ghassemi
,
Saeed Eshraghi
,
Farzaneh Amin Harati
Abstract
Clostridium difficile is the most common cause of nosocomial diarrhea. It is usually a consequence of antibiotic treatment, But sporadic cases can occur. This study was aimed to determine the frequency of the nosocomial Clostridium difficile (C. difficile) associated diarrhea in Tehran University of Medical Sciences hospitals and study of antibacterial susceptibility of isolates. In this study a total of 942 stool samples from patients with nosocomial diarrhea that were hospitalized in Imam Khomeini hospital, Shariati hospital and Children clinical center were collected. The samples were cultured on a selective cycloserine cefoxitin fructose agar (CCFA) and incubated in anaerobic conditions, at 37°C for 5 days. Isolates were characterized to species level by conventional biochemical tests. Bacterial cytotoxicity was assayed on tissue culture (vero). Antimicrobial sensitivity of isolated toxigenic C. difficile were investigated by kirby Beuer method (disk diffusion). Our findings show that, of the total patients, 57 toxigenic C. difficile (6.1%) were isolated. Results of statistical analysis show significant differences between the rate of isolated toxigenic C. difficile and age group of patients (P<0.05). Among the wards of selected hospitals, in gastroenterology of Children clinical center, Toxigenic C. difficile was isolated from patients most frequently. The sensitivity of isolates to vancomycin, Chloramphenicol and ceftriaxone were higher than other antibiotics. Toxigenic C. difficile is a common hospital-acquired infection. The organism was found in 6.1% hospitalized patients. Further studies to evaluate the rate and role of toxigenic C. difficile in nosocomial diarrheal processes, ecological and pathogenic terms are suggested.
Larson HE, Price AB, Honour P, Borriello SP. Clostridium difficile and the etiology of pseudomembranous colitis. Lancet 1978;1(8073):1063-6.
Bignardi GE. Risk factors for Clostridium difficile infection. J Hosp Infect 1998;40(1):1-15.
Hecht JR, Olinger EJ. Clostridium difficile colitis secondary to intravenous vancomycin. Dig Dis Sci 1989;34(1):148-9.
Anand A, Glatt AE. Clostridium difficile infection associated with antineoplastic chemotherapy: A review. Clin Infect Dis 1993;17(1):109-13.
Brazier JS. Role of the laboratory in investigations ofClostridium difficile diarrhea. Clin Infect Dis 1993;16 Suppl 4:S228-33.
Renshaw AA, Stelling JM, Doolittle MH. The lack of value of repeated Clostridium difficile cytotoxicity assays. Arch Pathol Lab Med 1996;120(1):49-52.
George WL, Sutter VL, Citron D, Finegold SM. Selective and differential medium for isolation of Clostridium difficile. J Clin Microbiol 1979;9(2):214-9.
Levett PN. Effect of antibiotic concentration in a selective medium on the isolation of Clostridium difficile from faecal specimens. J Clin Pathol 1985;38(2):233-4.
Peterson LR, Kelly PJ, Nordbrock HA. Role of culture and toxin detection in laboratory testing for diagnosis of Clostridium difficile-associated diarrhea. Eur J Clin Microbiol Infect Dis 1996;15(4):330-6.
Lennette EH, Spaulding EH, Truant JP. Manual of Clinical Microbiology. 2nd end. Washington, DC: American Society for Microbiology; 1974. p. 302-7.
Delmée M, Van Broeck J, Simon A, Janssens M, Avesani V. Laboratory diagnosis of Clostridium difficile-associated diarrhoea: a plea for culture. J Med Microbiol 2005;54(Pt 2):187-91.
McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320(4):204-10.
Cartmill TD, Panigrahi H, Worsley MA, McCann DC, Nice CN, Keith E. Management and control of a large outbreak of diarrhoea due to Clostridium difficile. J Hosp Infect 1994;27(1):1-15.
Fekety R. Guidelines for the diagnosis and management of Clostridium difficile-associated diarrhea and colitis. American College of Gastroenterology, Practice Parameters Committee. Am J Gastroenterol 1997;92(5):739-50.
Carner JS. Guideline for isolation precautions in hospitals. The hospital infection control practices advisory committee. Infect control Hosp Epidemiol, 1996; 17: 53-80.
Bartlett JG. Clostridium difficile history of its role as an enteric pathogen and current state of knowledge about the organism.Clin Infect Dis1994;18: S265-72.
Fan K, Morris AJ, Reller LB. Application of rejection criteria for stool cultures for bacterial enteric pathogens. J Clin Microbiol 1993;31(8):2233-5.
Poutanen SM, Simor AE. Clostridium difficile-associated diarrhea in adults. CMAJ 2004;171(1):51-8.
Ackermann G, Thomalla S, Ackermann F, Schaumann R, Rodloff AC, Ruf BR. Prevalence and characteristics of bacteria and host factors in an outbreak situation of antibiotic-associated diarrhoea. J Med Microbiol 2005;54(Pt 2):149-53.
20- Bowen KE, McFarland LV, Greenberg RN, Ramsey MM, Record KE, Svenson J. Isolation of Clostridium difficile at a university hospital: a two-year study. Clin Infect Dis 1995;20 Suppl 2:S261-2.
Olson MM, Shanholtzer CJ, Lee JT Jr, Gerding DN. Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infect Control Hosp Epidemiol 1994;15(6):371-81.
Eskiturk A, Soyletir G. A dilemma: infections in intensive care unit. J Turk Microbiol Soc 1994;,25:110-15.
Söyletir G, Eskitürk A, Kiliç G, Korten V, Tözün N. Clostridium difficile acquisition rate and its role in nosocomial diarrhoea at a university hospital in Turkey. Eur J Epidemiol 1996;12(4):391-4.
Bennett GC, Allen E, Millard PH. Clostridium difficile diarrhoea: a highly infectious organism. Age Ageing 1984;13(6):363-6.
McKay I, Coia JE, Poxton IR. Typing of Clostridium difficile causing diarrhoea in an orthopaedic ward. J Clin Pathol 1989;42(5):511-5.
Kaatz GW, Gitlin SD, Schaberg DR, Wilson KH, Kauffman CA, Seo SM, et al. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol 1988;127(6):1289-94.
Testore GP, Pantosti A, Cerquetti M, Babudieri S, Panichi G, Gianfrilli PM. Evidence for cross-infection in an outbreak of Clostridium difficile-associated diarrhoea in a surgical unit. J Med Microbiol 1988;26(2):125-8.
Bender BS, Bennett R, Laughon BE, Greenough WB 3rd, Gaydos C, Sears SD, et al. Is Clostridium difficile endemic in chronic-care facilities? Lancet 1986;2(8497):11-3.
Redelings MD, Sorvillo F, Mascola L. Increase in Clostridium difficile–related mortality rates, United States, 1999–2004. Emerg Infect Dis 2007;13:1417–9.
McDonald LC, Owings M, Jernigan DB. Clostridiumdifficile infection among patients discharged from US short- stay hospitals,1996–2003. Emerg Infect Dis 2006;12:409–15.
Pepin J, Valiquette L, Alary ME Clostridium difficile–associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466–72.
Brown E, Talbot GH, Axelrod P, Provencher M, Hoegg C. Risk factors for Clostridium difficile toxin-associated diarrhea. Infect Control Hosp Epidemiol 1990;11(6):283-90.
Valiquette L, Low DE, Pépin J, McGeer A. Clostridium difficile infection in hospitals: a brewing storm. CMAJ 2004;171(1):27-9.
Gerding DN, Olson MM, Peterson LR, Teasley DG, Gebhard RL, Schwartz ML, et al. Clostridium difficileassociated diarrhea and colitis in adults. A prospective case-controlled epidemiologic study. Arch Intern Med 1986;146(1):95-100.
McFarland LV, Mulligan ME, Kwok RY, Stamm WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989;320(4):204-10.
Zaidi M, Ponce de León S, Ortiz RM, Ponce de León S, Calva JJ, Ruiz-Palacios G, et al. Hospital-acquired diarrhea in adults: a prospective case-controlled study in Mexico. Infect Control Hosp Epidemiol 1991;12(6):349-55.
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| Issue | Vol 48, No 5 (2010) | |
| Section | Articles | |
| Keywords | ||
| Nosocomial infection diarrhea Clostridium difficik toxins biological antimicrobial sensitivity | ||
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