Prevalence of Clostridium difficile infections among hospitalized patients in Amman,Jordan: A Multi-Center Study

Abstract

Objective: To evaluate the prevalence of C. difficile infection (CDI) among hospitalized patients with toxin-positive stools. Methods: This study is a multicenter study held in Jordan and focused on the prevalence of in-patients with C. difficile toxin-positive diarrhea-stools. The study included three hospitals with approximately 750 beds. In-patients charts, laboratory logbooks for in-patients with diarrhea-stool specimens were reviewed. The participating hospitals used a rapid test, which detects fecal C. difficile toxins A and B. Results: 174 stool specimens were reviewed from March 2013 to October 2014, and 170 stool specimens from 168 patients were evaluated. The patients included 102 (60%) males, and 66 (40%) females including seven (10.6%) peripartum females. The patients were classified in the following age groups:neonates ≤ 28 days, infants 29 days-less than one year old (n = 4, 2.4%), 1-4 years (n = 3, 1.8%), and arbitrarily: 5-9 years (n = 3, 1.8%), 10-14 years (n = 3, 1.8%), 15-40 years (n = 33, 19.4%), 41-64 years, (n = 53, 31.2%) and ≥ 65 years were (n = 71, 41.8%).Adults and older age groups make up the majority of all patients (92.4%). Comorbidities were highly prevalent among the patients: diabetic (n = 71, 41.8%), chronic lung diseases (n = 25, 14.7%), solid tumors other than colonic tumors (n = 12, 7.1%), immune-suppressive state (n = 15, 8.8%), and one patient had colonic tumor. The majority of the patients (n = 21) were on more than one class of broad-spectrum antimicrobials. The prevalence of C. difficile toxin-positive stools were 14.63/1000 discharged patients, 12.65% of patients (12.96% of stool specimens)

Clostridium difficile: Infection, diagnosis and treatment with antimicrobial drugs : A review article

“…The second important risk factor is mostly observed among the elderly population. This is most likely due to changes in the intestinal microbiota, an increased use of antibiotic and more frequent hospitalization [3,28]. Advanced age has repeatedly been found to be a risk factor for CDI.…”

“…The study showed a prevalence of toxigenic C. difficile isolates was 13.7% among adult hospitalized patients, and 73% of the C. difficile isolates carried tcdA and/or tcdB toxin genes as demonstrated by PCR and in association with diarrhea, and all C. difficile isolates were negative for binary toxin production. A recent multicenter study held in Jordan in 2015 by Wadi et al [3], detected a prevalence rate of 92.4% among hospitalized old patients with C. difficile toxin-positive diarrhea-stools using a rapid test, which detects fecal C. difficile toxins A and B. The adults and older age groups accounted for the majority of all positive cases.…”

“…Dramatic increases in the incidence and severity of healthcare-associated C. difficile infection have occurred since 2000, particularly in patients over age 65 [3,5]. About 20% of patients with negative C. difficile stool cultures after admission become infected during their hospitalization.…”

“…Hospitalized patients may frequently develop antibiotic associated colitis or antibiotic associated diarrhea after short or long stay in hospitals [1][2]. In recent years, C. difficile infection (CDI) become an increasing heath problem in elderly hospitalized patients and as community-acquired infection, and which can be associated with high incidence, mortality, and healthcare costs [3,4].…”

Epidemiological Features of Clostridium difficile Colonizing the Intestine of Jordanian Infants

“…The current study indicates that there was no correlation between positive colonization of toxigenic C. difficile in infants and presence of soft stools, previous antibiotic treatment, or inflammatory bowel disease, and overall our findings were similar to that of other investigators [ 18 , 19 ]. A recent multicenter study done in three different private Jordanian hospitals in Amman over a period of 8 months showed high prevalence rate (92.4%) of positive C. difficile toxins among adults as well as older patients with a prolonged hospital stay and comorbidities [ 22 ]. Additionally, a recent study indicated that infants are widely colonized by nontoxigenic C. difficile strains and their early intestinal colonization with toxigenic strains originated from adults [ 9 ].…”