Chaudhry Rama, Sharma Nidhi, Gupta Nitin, Kant Kamla, Bahadur Tej, Shende Trupti M, Kumar Lalit, Kabra Sushil K
Professor, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Scientist, Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
J Clin Diagn Res. 2017 Sep;11(9):DC06-DC09. doi: 10.7860/JCDR/2017/29096.10592. Epub 2017 Sep 1.
Associated Diarrhoea (CDAD) is a significant cause of morbidity in hospitalised patients worldwide. The data on clinical epidemiology of this disease in Indian subcontinent is scarce.
To evaluate the risk factors and clinical course of patients with CDAD.
A cross-sectional study was planned at our tertiary care centre, All India Institute of Medical Sciences, whereby, all patients who had nosocomial diarrhea between 2010 and 2014 were included in the study. Their clinical and laboratory profile were recorded using structured questionnaire and their stool samples were subjected to ELISA for detection of toxins A and B (Premier toxins A and B). Those patients who had toxins A and B in their stool samples were diagnosed as CDAD. The clinical and laboratory profile of CDAD patients were further analysed.
A total of 791 patients with nosocomial diarrhea were included in this study. CDAD was diagnosed in a total of 48(6%) patients. The year wise breakdown of the positive patients is as follows: 7/135 (5.2%), 4/156 (2.6%), 5/141 (3.5%), 9/193 (4.7%) and 23/166 (13.8%), respectively. A total of 16/48 (33.3%) of CDAD cases belonged to the age group of 51-60 years. Malignancy (n=15, 31.25%) was the most common underlying pathological condition. All the patients had a history of antibiotic intake. Most common antibiotic used in the patients of CDAD was third generation cephalosporins (n=27, 56.25%). The use of clindamycin, carbapenems and colistin increased in the year 2014. Mean duration of hospital stay was 9.8 days. Diarrhoea was associated with fever in 50% of the patients while abdominal pain was seen in 39.6% of the patients.
The control of infection suffers from the rampant use of higher antibiotics. There is a need for proper implementation of antimicrobial stewardship programmes and better hospital infection control to stop the transmission of this nagging bug.
难辨梭状芽孢杆菌相关性腹泻（CDAD）是全球住院患者发病的一个重要原因。印度次大陆关于这种疾病临床流行病学的数据稀缺。
评估CDAD患者的危险因素和临床病程。
在我们的三级医疗中心——全印度医学科学研究所开展了一项横断面研究，纳入了2010年至2014年间所有发生医院内腹泻的患者。使用结构化问卷记录他们的临床和实验室资料，并对其粪便样本进行酶联免疫吸附测定（ELISA）以检测毒素A和B（普瑞米尔毒素A和B）。粪便样本中检测到毒素A和B的患者被诊断为CDAD。对CDAD患者的临床和实验室资料进行进一步分析。
本研究共纳入791例医院内腹泻患者。总共48例（6%）患者被诊断为CDAD。阳性患者按年份划分如下：分别为7/135（5.2%）、4/156（2.6%）、5/141（3.5%）、9/193（4.7%）和23/166（13.8%）。总共16/48（33.3%）的CDAD病例属于51 - 60岁年龄组。恶性肿瘤（n = 15，31.25%）是最常见的基础病理状况。所有患者都有抗生素使用史。CDAD患者中最常用的抗生素是第三代头孢菌素（n = 27，56.25%）。2014年克林霉素、碳青霉烯类和黏菌素的使用有所增加。平均住院时间为9.8天。50%的患者腹泻伴有发热，39.6%的患者有腹痛。
过度使用高级抗生素影响了感染控制。需要妥善实施抗菌药物管理计划并加强医院感染控制，以阻止这种恼人病菌的传播。
