Clostridium difficile infection (CDI) causes mild to severe diarrhoea and pseudomembranous colitis in patients who had prior antibiotic exposure. Despite CDI being prevalent worldwide, its epidemiological data is scanty in Malaysia. This study aimed to determine the prevalence and incidence of CDI at Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Stool specimens from 147-suspected CDI patients were obtained from 1 November 2011 until 31 October 2012. The presence of C. difficile toxin A and/or B were detected using a commercial immunochromatographic kit (Wampole™ Tox A/B Quik Chek). Surveillance data was collected from patients’ medical records to establish the demographic and clinical characteristics. The overall prevalence and incidence of CDI in UKMMC was 6.1% and 5.2 cases per 10 000 patient-days, respectively. Among nine CDI patients, 77.8% were males and 55.6% were Chinese. CDI was most common in medical wards (88.9%). The median age was 60 years and the median length of hospital stay was 13 days. Majority (88.9%) of CDI patients received antibiotics eight weeks prior to CDI. Penicillin-beta-lactamase inhibitors were the most common antecedent antibiotics. Five (55.6%) CDI patients received acid suppressant medications. The in-hospital mortality rate was 22.2%. In conclusion, the prevalence and incidence of CDI at UKMMC is relatively low and occurs sporadically.
Clostridium difficile Infection: Clinico-Epidemiological Perspective
Author
Abstrak
Jangkitan Clostridium difficile (CDI) menyebabkan cirit-birit ringan hingga tenat dan kolitis pseudomembran di kalangan pesakit yang mempunyai pendedahan antibiotik terdahulu. Walaupun CDI berleluasa di seluruh dunia, data epidemiologi berkaitan CDI secara relatifnya adalah sedikit di Malaysia. Kajian ini bertujuan menentukan prevalen dan insiden CDI di Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). Spesimen tinja tidak berbentuk daripada 147 pesakit yang disyaki menghidap CDI dari 1 November 2011 hingga 31 Oktober 2012 telah digunakan dalam kajian ini. Kehadiran toksin A dan/atau B C. difficile dikesan dengan menggunakan kit imunokromatografi komersial (Wampole™ Tox A/B QuikChek). Data pengamatan dikumpul daripada rekod kesihatan pesakit bagi mendapatkan ciri-ciri demografi dan klinikal. Keseluruhan prevalen dan insiden CDI di PPUKM masing-masing adalah 6.1% dan 5.2 kes per 10 000 hari-pesakit. Di kalangan sembilan orang pesakit CDI, 77.8% adalah lelaki dan 55.6% berbangsa Cina. CDI paling kerap berlaku di wad perubatan (88.9%). Median umur adalah 60 tahun dan median tempoh inap di hospital adalah 13 hari. Majoriti (88.9%) pesakit CDI telah menerima antibiotik lapan minggu sebelum mendapat CDI. Penisilin-perencat-beta-laktamase merupakan antibiotik yang paling kerap digunakan. Lima (55.6%) pesakit CDI telah menerima ubatan penindas asid. Kadar kematian di hospital adalah 22.2%. Kesimpulannya, prevalen dan insiden CDI dalam institusi ini secara relatifnya adalah rendah dan berlaku secara sporadik.
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