Department of Gastroenterology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Department of Experimental Medicine & Biotechnology, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Indian J Med Res. 2017 Jun;145(6):840-846. doi: 10.4103/ijmr.IJMR_192_16.
BACKGROUND & OBJECTIVES: 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 fluoroquinolones (13.1%), carbapenems (11.5%), glycopeptides (11.0%) and cephalosporins (8.4%). The clinical symptoms predominantly present were watery diarrhoea (56.4%), fever (40.0%) and abdominal pain (35.3%). The underlying diseases were gastrointestinal disorders (52.6%), followed by cancers (13.2%), surgical conditions (8.3%), and hepatic disorders (8.0%). Of the 174 C. difficile isolates, 54.6 per cent were toxigenic. Toxigenic C. difficile was present in all patients with surgical conditions, 65.2 per cent with cancers and 57.1 per cent with gastrointestinal disorders.
INTERPRETATION & CONCLUSIONS: C. difficile was found to be an important cause of gastrointestinal infections in hospitalized patients with underlying diseases and on antibiotics. Clinical conditions of the patients correlating with toxigenic culture can be an important tool for establishing CDI diagnosis.
艰难梭菌是接受抗生素治疗的患者医院获得性结肠炎的主要病原体。该生物体的致病性主要归因于毒素的产生。本研究旨在调查怀疑患有艰难梭菌感染（CDI）的住院患者粪便样本中是否存在产毒艰难梭菌，并将这些发现与他们的临床和人口统计学数据进行印证。
从 1110 名住院患者中采集腹泻样本，用于培养艰难梭菌，并通过表型和分子方法确认分离株。使用酶联免疫吸附试验测定分离株的毒素 A 和 B 的毒力。记录并分析了纳入研究的患者的详细信息。
在 1110 名患者（平均年龄 39±19.6 岁）中，63.9%为男性，36.1%为女性。患者主要接受的抗生素包括硝唑尼特（23.9%）、青霉素/青霉素组合（19.0%）、喹诺酮类包括氟喹诺酮类（13.1%）、碳青霉烯类（11.5%）、糖肽类（11.0%）和头孢菌素类（8.4%）。主要表现的临床症状为水样腹泻（56.4%）、发热（40.0%）和腹痛（35.3%）。基础疾病为胃肠道疾病（52.6%），其次为癌症（13.2%）、手术情况（8.3%）和肝脏疾病（8.0%）。在 174 株艰难梭菌分离株中，54.6%为产毒株。所有手术患者均存在产毒艰难梭菌，癌症患者中 65.2%和胃肠道疾病患者中 57.1%存在产毒艰难梭菌。
艰难梭菌是住院患者中基础疾病和使用抗生素后胃肠道感染的重要病原体。与产毒培养相关的患者临床状况可以作为建立 CDI 诊断的重要工具。
