Clostridium difficile Infection: Clinico-Epidemiological Perspective
Clostridium difficile Infection
Vol. 8 No. 2 : 2013 (64-72)
Abstract
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.
Keywords :
Clostridium difficile infection,
demographic characteristics,
incidence,
Malaysia,
prevalence,
Correspondance Address
Dr Ramliza Ramli, Department of Medical Microbiology and Immunology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455923 Fax: +603-91456671 Email: ramliza@ppukm.ukm.edu.my
References
Alcalá, L., Sánchez-Cambronero, L., Catalán, M.P., Sánchez-Somolinos, M., Peláez, M.T., Marín, M., Bouza, E. 2008. Comparison of three commercial methods for rapid detection of Clostridium difficiletoxins A and B from fecal specimens. J Clin Microbiol 46(11): 3833–35.
Aslam, S., Musher, D.M. 2006. An update on diagnosis, treatment andprevention of Clostridium difficile-associated disease. Gastroenterol Clin North Am 35(2): 315–35.
Bartlett, J.G. 1996. Management of Clostridium difficile infection and other antibiotic-associated diarrhoeas. Eur J Gastroenterol Hepatol 8(11): 1054-61.
Bartlett, J.G. 2008. Historical perspectives on studies of Clostridium difficileand C. difficileinfection. Clin Infect Dis 46(Suppl 1): 4–11.
Bliss, D.Z., Johnson, S., Savik, K., Clabots, C.R., Willard, K., Gerding D.N. 1998.Acquisition of Clostridium difficile and Clostridium difficile–associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med 129(12):1012–19.
Chung, C.H., Wu, C.J., Lee, H.C., Yan, J.J., Chang, C.M., Lee, N.Y., Chen, P.L., Lee, C.C., Hung, Y.P., Ko, W.C. 2010. Clostridium difficile infection at a medical center in Southern Taiwan: incidence, clinical features and prognosis. J Microbiol Immunol Infect 43(2): 119–25.
Cohen, S.H., Gerding, D.N., Johnson, S., Kelly, C.P., Loo, V.G., McDonald, L.C., Pepin, J., Wilcox, M.H. 2010.Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 31(5): 431-55.
Dumyati, G., Stevens, V., Hannett, G.E., Thompson, A.D., Long, C., MacCannell, D., Limbago, B. 2012. Community-associated Clostridium difficile infections, Monroe County, New York, USA. Emerg Infect Dis 18(3): 392-400.
Forster, A.J., Taljaard, M., Oake, N., Wilson, K., Roth, V., van Walraven, C. 2012. The effect of hospital-acquired infection with Clostridium difficileon length of stay in hospital. CMAJ 184(1): 37-42.
Hall, I., O’Toole, E. 1935. Intestinal flora in newborn infants with a description of a new pathogenic anaerobe Bacillus difficilis. Am J Dis Child 49(2): 390-402.
Hassan, S.A., Othman, N., Idris, F.M., Abdul Rahman, Z., Maning, N., Abdul Rahman, R., Tiong, C.G. 2012. Prevalence of Clostridium difficiletoxin in diarhoeal stool samples of patients from a tertiary hospital in North Eastern Peninsular Malaysia. Med J Malaysia 67(4): 402–5.
Jamal, W., Rotimi, V.O., Brazier, J., Duerden, B.I. 2010. Analysis of prevalence, risk factors and molecular epidemiology of Clostridium difficile infectionin Kuwait over a 3-year period. Anaerobe 16(6): 560-65.
Kim, H.H., Kim, Y.S., Han, D.S., Kim, Y.H., Kim, W.H., Kim, J.S., Kim, H., Kim, H.S., Park, Y.S., Song, H.J., Shin, S.J., Yang, S.K., Ye, B.D., Eun, C.S., Lee, K.M., Lee, S.H., Jang, B.I., Jung, S.A., Cheon, J.H, Choi, C.H., Huh, K. 2014. Clinical differences in Clostridium difficile infection based on age: a multicenter study. Scand J Infect Dis 46(1): 46–51.
Kyne, L., Sougioultzis, S., McFarland, L.V., Kelly, C.P. 2002. Underlying disease severity as a major riskfactor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol 23(11): 653-9.
Lai, C.C., Lin, S.H., Tan, C.K., Liao, C.H., Huang, Y.T., Hsueh, P.R. 2013. Clinical manifestations of Clostridium difficile infection in a medical center in Taiwan. J Microbiol Immunol Infect, pii: S1684-1182(13)00111-4.
Lee, Y.C., Wang, J.T., Chen, A.C., Sheng, W.H., Chang, S.C., Chen, Y.C. 2012. Changing incidence and clinical manifestations of Clostridium difficile-associated diarrhea detected by combination of glutamate dehydrogenase and toxin assay in Northern Taiwan. J Microbiol Immunol Infect 45(4): 287-95.
Lim, P.L., Barkham, T.M., Ling, L.M., Dimatatac, F., Alfred, T., Ang, B. 2008. Increasing incidence of Clostridium difficile–associated disease, Singapore. Emerg Infect Dis 14(9): 1487-89.
Manian, F.A., Aradhyula, S., Greisnauer, S., Senkel, D., Setzer, J., Wiechens, M., Meyer, P.L. 2007. Is it Clostridium difficile infection or something else? A case-control study of 352 hospitalized patients with new-onset diarrhea. South Med J 100(8): 782-6.
McFarland, L.V. 1998. Epidemiology, risk factors and treatments for antibiotic-associated diarrhea. Dig Dis 16(5): 292-307.
Parasakthi, N., Puthuceary, S.D., Goh, K.L., Sivanesaratnam, V. 1988. Clostridium difficile-associated diarrhoea: a report of seven cases. Singapore Med J 29(5): 504–7.
Peterson, L.R., Robicsek, A. 2009. Does my patient have Clostridium difficile infection? Ann Intern Med 151(3): 176-9.
Schroeder, M.S. 2005. Clostridium difficile–associated diarrhoea. Am Fam Physician 71(5): 921-8.
Simor, A.E., Williams, V., McGeer, A., Raboud, J., Larios, O., Weiss, K., Hirji, Z., Laing, F., Moore, C., Gravel, D. 2013. Prevalence of colonization and infection with methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus and of Clostridium difficileinfection in Canadian hospitals. Infect Control Hosp Epidemiol 34(7): 687-93.
Talpaert, M.J., Gopal Rao, G., Cooper, B.S., Wade, P. 2011. Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother 66(9): 2168–74.
Thibault, A., Miller, M.A., Gaese, C. 1991. Risk factors for the development of Clostridium difficile–associated diarrhea during a hospital outbreak. Infect Control Hosp Epidemiol 12(6): 345–48.
