RISK FACTORS FOR CLOSTRIDIUM DIFFICILE INFECTION IN PATIENTS ON ANTIBIOTICS

Abstract

Objective: To determine age, gender and duration of antibiotic intake as risk factors for Clostridium difficile infection in patients having diarrhoea after taking antibiotics.

Study design:Descriptive and cross-sectional.

Place & Duration of Study: Department of Microbiology, Fauji Foundation Hospital, Rawalpindi from January 2016 to June 2016.

Materials and Methods:A total of 180 patients were included in the study. The toxin cdA and cdB were detected by Immunochromatograhic technique using the kit manufactured by Remel (UK) on representative quantity of stool samples. All the patients were grouped according to age; one group of patients was 18 to 40 years old and other was 41 to 60 years. Depending on the type of antibiotics used patients were divided into 3 categories. Category 1 patients received third generation cephalosporin, category 2 patients received carbapenems & category 3 patients received other antibiotics like fluoroquinolones (ciprofloxacin, ofloxacin), penicillins, macrolides & chloramphenicol. Similarly patients were grouped into those who had received the antibiotics for 3-7 days or 8-14 days.

Results:The mean age (years) of the patient was 47.59+13.93(mean + SD) ranging from 18 to 60 years. There were 68 (37.8%) males and 112 (62.2%) female patients. Out of 180 patients, there were 8 (4.4%) patients who had Clostridium difficile in their stool sample & these all patients had age between 41 – 60 years. Among these 8 patients, 4 were males (n=68) & 4 were females (n=112) (p=0.466). Forty four patients were in age group from 18 to 40 years. None showed positivity for Clostridium difficile. One hundred and thirty six patients were in age group from forty one years to sixty years age group. Fifty patients were given cephalosporins. Among them six were positive for Clostridium difficile toxin (OR=8.73, 95% CI=1.70-44.84, p=0.0095) while 4 patients who were given carbapenems, among them two were positive for Clostridium difficile toxin (OR=28.33, 95% CI=3.39-236.61, p=0.0020). None of the patients who were given other antibiotics (n=126) was positive for Clostridium difficile.  One hundred and seventy-two patients were given antibiotics for 3-7 days while eight were given for 8-14 days. Six patients among first category & two among second category were positive for Clostridium difficile toxins. Prolonged duration was significant risk factor (OR=9.22, 95% CI=1.53-55.55, p=0.0153).

Conclusion:The significant risk factors for development of Clostridium difficile infection in patient on antibiotics include age above 40 years and prolonged use of cephalosporins and carbapenems.

Keywords: Clostridium difficile, Antibiotics associated diarrhoea, Immunochromatographic Technique, Toxin cdA & cdB.

RISK FACTORS FOR CLOSTRIDIUM DIFFICILE INFECTION IN PATIENTS ON ANTIBIOTICS