Incidence and Risk Factors of Clostridium difficile Infection Among Adult Patients Admitted to the Inpatient Department of a Tertiary Care Hospital: A Hospital-Based Observational Study

Abstract

BackgroundClostridium difficile infection (CDI) is a significant healthcare concern, marked by its rising prevalence and associated morbidity and mortality. However, there is limited data on the epidemiology of CDI in the eastern region of India. ObjectivesThe study aims to determine the incidence of CDI among adult patients admitted to the inpatient department of a tertiary care hospital and identify the risk factors associated with CDI. MethodologyA prospective observational study was conducted at a tertiary care hospital between October 2022 and March 2023. Using universal sampling, 200 adult patients were included in the study. Stool samples were collected within 24 hours of admission and again on the day of discharge or after one week, whichever period was longer. Relevant clinical, demographic, and laboratory data were also collected. The stool samples were analyzed for C. difficile toxins A and B using an enzyme immunoassay. Statistical analysis was performed using the mean and independent t-test for continuous variables, while proportions and Chi-square or Fisher's exact tests were applied for categorical variables. ResultsThe incidence of CDI during the study period was 9%. The participants had a mean age of 46.49 ± 16.78 years, with a predominance of males (60%). Acute febrile illness was the most common diagnosis at admission (36%). The mean duration of hospitalization was significantly longer in patients who tested positive for C. difficile toxins via enzyme-linked immunosorbent assay compared to those who tested negative (8.0 ± 1.53 days vs. 3.75 ± 1.25 days, p < 0.001). Exposure to broad-spectrum antibiotics, particularly third-generation cephalosporins, was significantly associated with CDI development. Additionally, fecal leukocytes were detected in all (100%) patients who tested positive for C. difficile toxins. ConclusionsThis study offers important insights into the incidence and risk factors of CDI among adult patients in a tertiary care setting. The findings emphasize the need for the judicious use of broad-spectrum antibiotics to reduce the risk of CDI. Additionally, the detection of fecal leukocytes may serve as a valuable diagnostic marker for CDI in clinical practice.