Nozokomiyal Diyarelerdeki Clostridium difficile İnsidansı Atlanıyor mu?

Abstract

Clostridium difficile (C. difficile) is a Gram-positive, obligatory anaerobe, spore-forming microorganism and is highly associated with the nosocomial infections. The incidince of nosocomial diarrhoea and C. difficile-associated nosocomial diarrhoea rates are not clear in our country. To determine the C. difficile-associated nosocomial diarrhoea incidence, to review the current resistance status of C. difficile, and to evaluate diagnostic and therapeutic approaches for this pathogen were the aims of the present study. This prospective clinical study included 100 diarrhoea samples from hospitalized patients in Istanbul University Cerrahpasa Medical Faculty of. The diarrhoea samples were investigated by culture, card test and ELISA methods and bacterial resistance profiles were shown with the E-test method. Toxin A/B was found positive at 30/100 patients (30%) by ELISA. The duration of hospitalization and diarrhoea period were significantly longer in Toxin A/B positive patients than negative patients (p<0.05). Recurrences detected in 41% of Toxin A/B positive patients (statistically not significant but clinically may be important). When ELISA was accepted as the main test, the sensitivity and specificity of culture and card test methods were found as 56%, 75% and 76%, 80%, respectively. The C. difficile resistance rates were determined for metronidazole as 29.4%, for vancomycin and teikopilanin as 2.9%. Our results support that the C. difficile is still an important factor in nosocomial diarrhoea. Furthermore, highness of antibiotic resistance for metronidazole may be caused by difficulties in treatment. The results indicate the necessity of further studies to develop control measures and effective treatment options for patients.