Magnitude of Clostridium Difficile Infection in Hospitalized Egyptian Patients with Liver Cirrhosis

Abstract

Background and Aim: Watery diarrhea is the cardinal clinical symptom of Clostridium Difficile infection that causes a spectrum of manifestations ranging from asymptomatic carrier state to severe fulminant disease with toxic megacolon. The basis for symptomatic responses range is related to host and pathogen factors. We studied the prevalence of Clostridium Difficile infection in hospitalized cirrhotic patients and its possible risk factors. Patients and methods: This study was carried out on 200 cirrhotic patients admitted to National Liver Institute hospital divided into 2 groups: 100 asymptomatic patients and 100 patients with diarrhea. Direct stool toxin detection was done using an assay named RIDASCREEN® Clostridium Difficile Toxin A/B test; an enzyme immunoassay (EIA) for the qualitative determination of toxins A and B of Clostridium difficile in stool. Results: Among 200 patients with mean age of (51.81 ± 12.94), EIA revealed 16 and 32 positive cases in both groups. In group I, there was statistical significance in ALT, serum creatinine (p<0.05) and bilirubin level (p<0.01) as regard EIA test result. Also, statistical significance was found (p<0.05) as regard duration of antibiotic and PPI intake. Logistic regression analysis revealed that gender and duration of PPIs use were independent factors in group I while the patient’s age, duration of antibiotic use and γ-GT serum level were independent factors in group II for clostridium difficile infection development. Conclusion: Clostridium difficile infection is not an uncommon infection in hospitalized cirrhotic patients. Risk factors were antibiotic intake, gastric acid suppression, old age, long hospital stay and/or history of bilharziasis.