Pancreatic disease patients are at higher risk for Clostridium difficile infection compared to those with other co-morbidities

Chetana Vaishnavi,Pramod K Gupta,Megha Sharma,Rakesh Kochhar

doi:10.1186/s13099-019-0300-2

Abstract

BackgroundSurveillance of Clostridium difficile infection (CDI) in patients with underlying diseases is important because use of prophylactic antibiotics makes them prone to CDI. Epidemiology of CDI in this high-risk population is poorly understood. A study was conducted to evaluate the impact of CDI in patients with specific underlying co-morbidities.MethodA total of 2036 patients, whose fecal samples were processed for C. difficile toxin A and B assay by ELISA formed the basis of study. Patients with underlying diseases were classified based on the organ/kind of disease as pancreatic (n = 340), renal (n = 408), hepatic (n = 245), malignant (n = 517) and miscellaneous disease (n = 526). Laboratory records of clinical and demographic details were reviewed. The association of CDI with age, gender, antibiotic receipt, clinical symptoms and underlying co-morbidities was analyzed. Variation in CDI cases based on age groups was also investigated.ResultClostridium difficile toxin positivity was 21.6% in general, whereas it was 30.6% in the pancreatic, 17.9% in the renal, 19.6%, in the hepatic, 21.3% in the malignancy and 20.0% in the miscellaneous disease groups. Toxin positivity was the lowest (14.8%) for female gender under renal disease and the highest (31.8%) for patients aged 40 to < 60 years, under pancreatic disease. Bloody diarrhea was a significant predictor for C. difficile toxin positivity. C. difficile toxin status irrespective to the underlying diseases was neither dependent on gender, age-groups or the number of antibiotics used. Association between patients’ gender, age and antibiotics receipt with underlying disease conditions, respective to C. difficile toxin status showed significance in relation to male gender (p < 0.05), age 40 to < 60 years (p = 0.03) and those receiving single (p = 0.09) or multiple antibiotics (p = 0.07).ConclusionPancreatic disease patients are at a higher risk for developing CDI, and particularly male gender, age 40 to < 60 years and those receiving antibiotics are at significant risk.

Highlights

Clostridium difficile is the causative microbe for almost all cases of pseudomembranous colitis and 15–25% of antibiotic associated diarrhea [1]
Pancreatic disease patients are at a higher risk for developing Clostridium difficile infection (CDI), and male gender, age 40 to < 60 years and those receiving antibiotics are at significant risk
During the study period of 7 years, 307,299 patients were admitted to the various wards of the hospital. Of these stool samples from patients suspected to have CDI by the treating team were sent to our laboratory for C. difficile toxin assay

Summary

Introduction

Clostridium difficile is the causative microbe for almost all cases of pseudomembranous colitis and 15–25% of antibiotic associated diarrhea [1]. Patients with underlying diseases generally receive prophylactic antibiotics, making them prone to acquire CDI. The surveillance of CDI precipitated by underlying diseases is important as there is very little literature investigating the same. The association of CDI in patients with inflammatory bowel diseases (IBD) was investigated to assess the role of IBD as a risk factor [6]. As a further extension to the study, a retrospective, observational investigation was conducted to evaluate the association of CDI in patients with specific underlying co-morbidities like pancreatic, hepatic, renal and malignant diseases and compared with those of other miscellaneous diseases. Surveillance of Clostridium difficile infection (CDI) in patients with underlying diseases is important because use of prophylactic antibiotics makes them prone to CDI. A study was conducted to evaluate the impact of CDI in patients with specific underlying co-morbidities

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Results

Discussion

Conclusion