Title: Rapid Diagnosis of Toxigenic Clostridium difficile in elderly patients in Tertiary setup
Authors: Dr Geethu Thomas MBBS MD (Microbiology), Dr M.N.Sumana MBBS MD, Mr Anshu Kumar Yadav
DOI: https://dx.doi.org/10.18535/jmscr/v5i7.15
Abstract
Background: Antibiotics cause diarrhoea due to infection by antibiotic resistant pathogens such as Staphylococcus aureus, Clostridium difficile, Candida albicans, Salmonella, C.perfringens type A, Klebsiella oxytoca, etc. CDAD (Clostridium difficile associated disease) is responsible for 15-25% of cases of AAD.2 C. difficile associated disease (CDAD) is a serious condition with mortality up to 25 per cent in frail elderly people.1 The average age of those with CDI is nearly 20 years older than the average age of those with hospitalization for other reasons.3 Laboratory diagnosis is based on culture and toxin detection in fecal specimens. Culture is very sensitive but if carried out without toxin testing, may lead to misdiagnosis of CDAD as it detects even asymptomatic cases.4 C.DIFF QUIK CHEK COMPLETE® test is a rapid cassette assay that simultaneously detects both glutamate dehydrogenase (GDH) antigen and toxins A & B of C.difficile in fecal specimens. This test when compared to Toxigenic Culture and PCR showed that 88% could be accurately screened as positive or negative.5
Objective: To approximate the frequency of CDI in elderly patients on antibiotics with diarrhoea, in whom other possible causes are ruled out.
Methods: Stool samples of patients from ICUs and surgical wards who were above 65 years of age with diarrhoea who received antibiotics for 7 days or more were tested after ruling out other possible causes of AAD using Enzyme immuno assay test.
Results: 32 (64%) samples were GDH antigen positive, 8(16%) were positive both for GDH and toxin.