Clostridium difficile in association with sporadic diarrhoea.

Area of Science:

• Infectious Diseases
• Microbiology
• Gastroenterology

Background:

• Sporadic diarrheal disease is a common reason for admission to infectious diseases units.
• Clostridium difficile is a bacterium known to cause diarrhea, often associated with antibiotic use.

Purpose of the Study:

• To investigate the occurrence and potential association with antibiotics of Clostridium difficile in patients with sporadic diarrheal disease.
• To evaluate the pathogenic potential of Clostridium difficile in this patient cohort.

Main Methods:

• Prospective survey of 154 patients admitted to an infectious diseases unit over one year.
• Stool sample analysis for the presence of Clostridium difficile.
• Assessment of patient history, including recent antibiotic use.
• Detection of Clostridium difficile cytotoxin in faecal samples.

Main Results:

• Clostridium difficile was isolated from 19 patients.
• In severe/moderately severe illness, C. difficile was the sole pathogen in 10/12 patients; 7 had recent antibiotics, 5 did not.
• In moderate/mild illness, C. difficile was found in 7 patients; 2 had recent antibiotics, 2 did not.
• Faecal C. difficile cytotoxin was detected in only 6 patients, often at low levels.
• The occurrence of C. difficile could not be described as antibiotic-associated in this study.

Conclusions:

• Clostridium difficile can be present in patients with diarrhea irrespective of recent antibiotic exposure.
• Antibiotic history alone is insufficient to determine the role of C. difficile in diarrheal illness.
• A pathogenic index for C. difficile should consider bacterial load and toxigenic potential.