TITLE:
Association of Clostridium difficile with Antibiotic Associated Diarrhea among Hospitalized Children in Diyala-Iraq
AUTHORS:
Abdulrazak S. H. Hasan, Rana S. M. Al-Zubaidi, Abbas A. Al-Duliami
KEYWORDS:
Cl. difficile, Glutamate Dehydrogenase, Antibiotic Associated Diarrhea
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.7 No.2,
February
2,
2019
ABSTRACT: Background: Clostridium difficile infection (CDI) is an
increasingly important cause of morbidity in hospitalized children. Absence of clinical
suspicion and suboptimum laboratory diagnostic methods are behind the
misdiagnosed infections. Objectives: To determine the association of Cl.
difficle infection among hospitalized children suspected of having
antibiotic associated diarrhea (AAD) plus detection of the bacterium’s toxins A
and B and the enzyme glutamate dehydrogenase
(GDH). Patients and methods: This cross-sectional study was
conducted in Al-Batool Hospital for Maternity and Children in Baquba City for
the period from March 2017 to April 2018. Sixty stool samples were collected
from children inpatients. The age range was 15 days up to one year. 41 (68.3%)
and 19 (31.7%) were males and females respectively. Additionally, 20 healthy
children were enrolled as control group. The age range was 50 days up to one
year, 12 (60%) and 8 (40%) were males and females respectively. Special
questionnaire was preconstructed for collection of demographic information.
Isolation of Cl. difficile was carried out on Colombia blood agar and
tryptose sulfite cycloserine agar. Enzyme linked immunosorband assays were used
for the detection of toxin A and B (CerTest-Biotec, Spain), and for the
detection of glutamate dehydrogenase enzyme (CerTest-Biotec, Spain). Human
privacy was respected by obtaining the parents’ oral consent.
Statistical analyses were done using SPSS Version 18 and P values less than
0.05 were considered significant. Results: The isolation rate of Cl.
difficile form patients and healthy children was 11.7% and 5% respectively. The toxins detection rate among patients was 23.3%, of these 35.7% for
toxin A, and 64.3% for toxin A and B together. Neither of the patients’
specimens was positive for toxin B alone, nor was healthy control positive for
all toxins. The overall detection rate of GDH enzyme in study groups was 32.5%,
with a significantly higher among patients as compared to control (28.8% vs. 3.8% , P = 0.045).
The isolation and detection rate of Cl. difficile were increased as the
time of the onset of diarrhea was increased. Other factors: age, sex, residence,
and type of feeding were insignificantly affecting the isolation and
detection rate of Cl. difficile by different techniques. The third
generation cephalosporines either singly or in combinations with each other or
with another antibiotic were mostly associated with the higher rates of
diarrhea. Conclusion: Cl. difficile infection is
associated with about one third of antibiotic associated diarrhea among
hospitalized children one year of age in Diyala province. CDI should be
included in the routine differential diagnoses for hospitalized children
presenting with AAD.