A Review of Clostridium Difficile Infection at the University Hospital of the West Indies, Jamaica

Overview

Journal West Indian Med J

Specialty General Medicine

Date 2015 Dec 2

PMID 26624597

Citations 1

Authors

N Clare-Pascoe

M G Lee

T Murphy

A Nicholson

T S Ferguson

Affiliations

Soon will be listed here.

Abstract

Objectives: This study examined the frequency of Clostridium difficile infection (CDI) among hospital admission and diarrhoeal stool samples over a six-year period.

Methods: A review of all suspected cases of C difficile positive patients from 2007 to 2012 at the University Hospital of the West Indies (UHWI), Jamaica, was performed. Clostridium difficile infection was confirmed by clinical features and a positive enzyme-linked immunosorbent assay (ELISA) stool test for Clostridium Toxins A and B. The demographics, clinical features, risk factors, treatment and outcomes were also examined.

Results: There were 56 patients reviewed. The most commonly affected age group was 40-59 years of age. The proportion of CDI cases per total stool samples increased from 0.5% in 2007 to 5.9% in 2010 then fell to 2.2% in 2011 but increased again to 4.3% in 2012. The proportion of cases per total UHWI admissions also increased from 0.12 cases per 1000 admissions in 2007 to 1.16 in 2010 and 1.36 in 2012 (p < 0.001). Most CDI cases were nosocomial (76% males, 48.6% females). Co-morbidities included hypertension and end-stage renal disease. Ceftazidime was the most common antibiotic associated with the development of CDI. Resolution occurred in 62.5% of patients. Duration of hospital stay was longer in males than females (≥ 21 versus < 7 days) and males had more adverse outcomes, with death in 23.8% versus 11.4%.

Conclusion: There has been an increase in the frequency of CDI at UHWI with a greater than expected frequency of community acquired CDI. Increased awareness is needed of the increasing risk for CDI and measures must be taken to prevent the disease, especially in hospitalized patients.

Citing Articles

Nagging Presence of Associated Diarrhoea in North India.

Chaudhry R, Sharma N, Gupta N, Kant K, Bahadur T, Shende T J Clin Diagn Res. 2017; 11(9):DC06-DC09.

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References

Wanahita A, Goldsmith E, Marino B, Musher D . Clostridium difficile infection in patients with unexplained leukocytosis. Am J Med. 2003; 115(7):543-6. DOI: 10.1016/s0002-9343(03)00420-0. View

Pepin J, Valiquette L, Cossette B . Mortality attributable to nosocomial Clostridium difficile-associated disease during an epidemic caused by a hypervirulent strain in Quebec. CMAJ. 2005; 173(9):1037-42. PMC: 1266326. DOI: 10.1503/cmaj.050978. View

Sears C, Kaper J . Enteric bacterial toxins: mechanisms of action and linkage to intestinal secretion. Microbiol Rev. 1996; 60(1):167-215. PMC: 239424. DOI: 10.1128/mr.60.1.167-215.1996. View

Quan H, Li B, Couris C, Fushimi K, Graham P, Hider P . Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011; 173(6):676-82. DOI: 10.1093/aje/kwq433. View

Pepin J, Valiquette L, Alary M, Villemure P, Pelletier A, Forget K . Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ. 2004; 171(5):466-72. PMC: 514643. DOI: 10.1503/cmaj.1041104. View

Mitchell B, Gardner A . Mortality and Clostridium difficile infection: a review. Antimicrob Resist Infect Control. 2012; 1(1):20. PMC: 3533881. DOI: 10.1186/2047-2994-1-20. View

McDonald L, Owings M, Jernigan D . Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996-2003. Emerg Infect Dis. 2006; 12(3):409-15. PMC: 3291455. DOI: 10.3201/eid1205.051064. View

Johnson S, Samore M, Farrow K, Killgore G, Tenover F, Lyras D . Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med. 1999; 341(22):1645-51. DOI: 10.1056/NEJM199911253412203. View

Bakken J, Borody T, Brandt L, Brill J, DeMarco D, Franzos M . Treating Clostridium difficile infection with fecal microbiota transplantation. Clin Gastroenterol Hepatol. 2011; 9(12):1044-9. PMC: 3223289. DOI: 10.1016/j.cgh.2011.08.014. View

10.

Loo V, Poirier L, Miller M, Oughton M, Libman M, Michaud S . A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005; 353(23):2442-9. DOI: 10.1056/NEJMoa051639. View

11.

Sheth H, Bernardini J, Burr R, Lee S, Miller R, Shields M . Clostridium difficile infections in outpatient dialysis cohort. Infect Control Hosp Epidemiol. 2009; 31(1):89-91. DOI: 10.1086/648448. View

12.

Bulusu M, Narayan S, Shetler K, Triadafilopoulos G . Leukocytosis as a harbinger and surrogate marker of Clostridium difficile infection in hospitalized patients with diarrhea. Am J Gastroenterol. 2000; 95(11):3137-41. DOI: 10.1111/j.1572-0241.2000.03284.x. View

13.

Nelson R, Kelsey P, Leeman H, Meardon N, Patel H, Paul K . Antibiotic treatment for Clostridium difficile-associated diarrhea in adults. Cochrane Database Syst Rev. 2011; (9):CD004610. DOI: 10.1002/14651858.CD004610.pub4. View

14.

Bartlett J, MOON N, Chang T, Taylor N, Onderdonk A . Role of Clostridium difficile in antibiotic-associated pseudomembranous colitis. Gastroenterology. 1978; 75(5):778-82. View

15.

Peled N, Pitlik S, Samra Z, Kazakov A, Bloch Y, Bishara J . Predicting Clostridium difficile toxin in hospitalized patients with antibiotic-associated diarrhea. Infect Control Hosp Epidemiol. 2007; 28(4):377-81. DOI: 10.1086/513723. View

16.

Pothoulakis C, Sullivan R, Melnick D, Triadafilopoulos G, Gadenne A, Meshulam T . Clostridium difficile toxin A stimulates intracellular calcium release and chemotactic response in human granulocytes. J Clin Invest. 1988; 81(6):1741-5. PMC: 442619. DOI: 10.1172/JCI113514. View

17.

Zilberberg M, Tillotson G, McDonald C . Clostridium difficile infections among hospitalized children, United States, 1997-2006. Emerg Infect Dis. 2010; 16(4):604-9. PMC: 3363321. DOI: 10.3201/eid1604.090680. View

18.

Pillai A, Nelson R . Probiotics for treatment of Clostridium difficile-associated colitis in adults. Cochrane Database Syst Rev. 2008; (1):CD004611. DOI: 10.1002/14651858.CD004611.pub2. View

19.

Khanna S, Pardi D, Aronson S, Kammer P, Orenstein R, St Sauver J . The epidemiology of community-acquired Clostridium difficile infection: a population-based study. Am J Gastroenterol. 2011; 107(1):89-95. PMC: 3273904. DOI: 10.1038/ajg.2011.398. View