Prevalence of clostridium difficile among cases of antibiotics associated diarrhea in hospitalized patients in an Egyptian hospital

Abstract

Background and aim of the work: Clostridium difficile associated diarrhea is an important nosocomial infection that occurs predominantly after hospitalization and administration of broad spectrum antibiotics. In this work we aimed to determine the prevalence of toxigenic C. difficle among cases of AAD in Cairo university hospitals in Egypt using specific Polymerase Chain Reaction protocols. Patients and methods: Stool samples were collected from 100 adult cases (19-59 years old) admitted in wards and ICUs of Cairo- University hospitals in Egypt, clinically suffering from AAD and twenty healthy individuals as a control group and subjected to direct microscopy examination, culture on blood agar media and chromognic culture media for C. difficile and finally molecular detection of C. difficile DNA using multiplex Polymerase chain Reaction of triose phosphate isomerase gene tpi, tcdA and tcdB genes which code for toxin A as an enterotoxin and toxin B as a cytotoxin respectively and cdtA and cdtB as an enzymatic and binding component respectively of binary toxin. Results: Two out of 100 cases were positive for the ctdB gene (toxin B) and tpi gene and one of the two positive cases was also positive for cdtA and cdtB (binary toxin). No cases were positive for tcdA toxin A. Regarding control group no samples were positive for any of the tested genes. Conclusion: This study confirms the accuracy and reliability of PCR methodology in the detection of toxigenic C. difficile, offering combined species identification and toxigenic type characterization, and suggests that C. difficile is responsible for a small, but underappreciated, proportion of antibiotic associated diarrheal cases in our country, and further study on a large scale is warranted in this area.