Prevalence of Clostridium difficile toxin in diarrhoeal stool samples of patients from a general hospital in eastern province, Saudi Arabia

Clostridium difficile is anaerobic spore-forming bacillus, produces two major toxins (Tcd A and Tcd B). Disease caused by toxigenic C.difficile (Tcd) varies from mild diarrhea to fulminant disease and death.

This study describes the prevalence of C.difficile toxins (CDT) in stool samples from in patients and outpatients of all age groups.

A total of 146 samples were examined from 2011 to 2012 were analyzed for the presence of CDT tests, DNA amplification test, and the stool samples were cultured anaerobically on CCFA selective medium for growth-Morphology, identification and other tests. The patient's details are collected from the medical records.

Out of 146 specimens, only 20 (13.7%) were positive for C.difficile toxins. Male and female were 12 (60%) and 8(40%) respectively, with the majority of them aged between 16 to 71 years. Majority of them were from out patient units (n = 5, 25%) with rest from intensive care units (n = 3, 15%), male medical ward (n =3, 15%) and surgical wards (n = 1, 5%). All the CDT positive patients had history of prior antibiotic usage before the detection of toxin. Mean duration of antibiotic usage was a 16.75 (±12.75) days, and the mean duration of diarrhea was 4.21 (±4.85) days, 16 patients had underlying medical illness, like hypertension, diabetic mellitus etc; Stool with pus cells and occult blood test was positive among that 18 patients were positive for CDT. The hospitalized patient duration was 20.96 (±16.25) days.

The detection of CDT in the diagnosis of CDI requires vigilance by both clinician and microbiologist to look out for possible infected patients. Antibiotic usage is a known risk factor; thus restricted use of antibiotics may results the reduction of CDI.