Clostridioides difficile Diarrhea: An Emerging Problem in a South Indian Tertiary Care Hospital

Kannambath, Rachana; Biswas, Rakhi; Mandal, Jharna; Vinod, Kolar V.; Dubashi, Biswajit; Parameswaran, Narayanan

doi:10.1055/s-0041-1731944

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…Colonization and infection with CD can also be stimulated by acid suppression due to usage of PPI. 16 In our study,18 out of 32 patients were on PPI. This could also have promoted the development of CDI in these patients.…”

Section: Discussionmentioning

confidence: 79%

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Antibiotic-Associated Clostridium difficile Diarrhoea in Tertiary Care Hospital – A Study from Western India

Bhatawadekar¹,

Yadav²,

Babu³

et al. 2023

J. Pure Appl. Microbiol.

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Antibiotic-associated Clostridium difficile (CD) diarrhoea is one of the common causes of healthcare-acquired infection. Cephalosporins, piperacillin-tazobactam and aminoglycosides are the common antibiotics which have the maximum chances of producing Clostridium difficile infection (CDI). Most Asian countries have easy accessibility to many of these antibiotics without prescription. Broad spectrum antibiotics have been indiscriminately used as empirical therapy over the last two decades which has resulted in an increased risk of C. difficile infection. In India, the prevalence of CDI is highly underestimated. This study aims to understand the prevalence, risk factors and comorbidities associated with CD diarrhoea in a tertiary care hospital from western India. 196 patients were included in the study who were diagnosed with antibiotic-associated diarrhoea (AAD) clinically. Stool samples collected were processed for anaerobic culture of C. difficile and immunochromatography test was done to detect C. difficile toxins A and B. The comorbidities associated as well as the use of antibiotics like cephalosporin or proton pump inhibitors were also noted for the patients with CDI. 32 samples yielded CD (16%), out of which toxin production was detected only in 16 isolates. The prevalence rate of CDI in our hospital was 5%. Most of the patients had history of chronic illnesses like diabetes mellitus, chronic kidney disease, ischemic heart disease, systemic hypertension, autoimmune diseases, or malignancy. Avoiding empirical therapy with antibiotics prone to cause AAD, Antimicrobial stewardship programme with proper infection control practices and epidemiological surveillance of CDI will help to reduce the burden of CDI in our country.

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Section: Discussionmentioning

confidence: 79%

“…This was similar to the study done by Segar et al where the prevalence of CDI was 4%. 14 3,15,16 The reason for the lower prevalence could be due to the adhesion to the antibiotic policy adopted in our hospital and strict implementation of infection control practices.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic-Associated Clostridium difficile Diarrhoea in Tertiary Care Hospital – A Study from Western India

Bhatawadekar¹,

Yadav²,

Babu³

et al. 2023

J. Pure Appl. Microbiol.

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“…This variation in prevalence can be attributed to the dissimilar study population characteristics and the variation in the testing algorithm used in different studies; those that used molecular techniques for the detection of CDI had a higher prevalence, as shown by Kannambath et al who observed an increase from 12 to 18.68% in prevalence by using molecular assays. 29 Although these molecular assays have increased sensitivity they may lead to overdiagnosis of CDI because they only detect the toxin gene which may or may not be functional to produce toxin/disease in patients.…”

Section: Discussionmentioning

confidence: 99%

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

Sen,

Das,

Singh

et al. 2024

Euroasian Journal of Hepato-Gastroenterology

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A bstract 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. How to cite this article Raj N, Agarwal J, Singh V, et al . Healthcare-associated Diarrhea due to Clostridioides difficile in Patients Attending a Tertiary Care Teaching Hospital of North India. Euroasian J Hepato-Gastroenterol 2024;14(1):60–64.

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“…8 A 2021 study from a tertiary care center in south India showed the prevalence of CDAD in cancer patients to be 18.67%. 9 Due to the lack of large-scale data and multicentric studies, the true burden of this problem is unknown in India. Lack of uniform availability of testing infrastructure as well as access to therapy is among the challenges faced in Indian settings.…”

Section: Introductionmentioning

confidence: 99%

“…8 A 2021 study from a tertiary care center in south India showed the prevalence of CDAD in cancer patients to be 18.67%. 9…”

Section: Introductionmentioning

confidence: 99%

Clostridium difficile in Oncology Patients—Review of Diagnosis and Management in the Indian Setting

Prayag

Patwardhan

Panchakshari

et al. 2023

Indian J Med Paediatr Oncol

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Clostridoides (formerly Clostridium) difficile (C. difficile) is a toxin-producing, gram-positive anaerobic bacillus, commonly implicated in antibiotic-associated diarrhea and pseudomembranous colitis. The true burden of C. difficile infection is unclear in India, as it is likely underdiagnosed and underreported. Its incidence is much higher in oncology patients where it can contribute significantly to morbidity and mortality. There are several challenges in the Indian setting, including lack of uniform availability of testing infrastructure, as well as therapy. Oncology patients further present with a unique set of challenges. This article will review the approach to diagnosis and management of C. difficile-associated diarrhea in India, with a focus on oncology patients.

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Clostridioides difficile Diarrhea: An Emerging Problem in a South Indian Tertiary Care Hospital

Cited by 4 publications

References 27 publications

Antibiotic-Associated Clostridium difficile Diarrhoea in Tertiary Care Hospital – A Study from Western India

Antibiotic-Associated Clostridium difficile Diarrhoea in Tertiary Care Hospital – A Study from Western India

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

Clostridium difficile in Oncology Patients—Review of Diagnosis and Management in the Indian Setting

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