Abstract
BackgroundClostridium difficile infection (CDI) is not generally reported to public health authorities in the Middle East and its true prevalence remains largely unknown. The aims of this study were to determine the prevalence of CDI and its associated ribotypes among C. difficile isolates in Qatar. Influence of age and correlation with other risk factors e.g. proton pump inhibitor use, antibiotic use, existence of chronic conditions, etc was also investigated for CDI positive patients.MethodsA total of 1,532 patients with suspected CDI were recruited from two hospitals between 2011 and 2012. C. difficile was identified using glutamate dehydrogenase (GDH) lateral flow assay and toxins A and B Enzyme Immunoassay (EIA). The C. difficile positive samples were then cultured for PCR-ribotyping.Results122 of the 1,532 (7.9%) samples from individual patients were identified as C.difficile positive; and 79 of these were viably cultured (~65%). From these, 36 different PCR ribotypes were isolated, of which strains 258 (6 [7.6%]), 01/014/046 (5 [6.3%]), and 011/053/056/107 (4 [5%]) were the most prevalent. The prevalence of PCR-ribotype 027 was 1.3% (n = 1). An age of ≥65 years and treatment with proton pump inhibitors correlated with higher frequency of CDI. Treatment with third generation cephalosporins (50 [41%]) and piperacillin/tazobactam antibiotics (55 [45.1%]) was most frequently associated with CDI.ConclusionThe most common C. difficile ribotype identified in Qatar was 258, which is different from those found in North America, Europe and Asia. The prevalence of CDI was higher in Qatar than Europe; though comparable to other Middle Eastern countries. These findings underscore the importance of local surveillance to detect and control C. difficile infection.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-502) contains supplementary material, which is available to authorized users.
Highlights
Clostridium difficile infection (CDI) is not generally reported to public health authorities in the Middle East and its true prevalence remains largely unknown
Infection with Clostridium difficile is a common cause of diarrhoea, especially diarrhoea associated with a history of antibiotic use [1]
The aim of the present study is to investigate the epidemiology of CDI in patients admitted to Hamad General Hospital and Al-Khor Hospital in Qatar and identify the specific ribotypes associated with CDI in Qatar
Summary
Clostridium difficile infection (CDI) is not generally reported to public health authorities in the Middle East and its true prevalence remains largely unknown. The aims of this study were to determine the prevalence of CDI and its associated ribotypes among C. difficile isolates in Qatar. Influence of age and correlation with other risk factors e.g. proton pump inhibitor use, antibiotic use, existence of chronic conditions, etc was investigated for CDI positive patients. Infection with Clostridium difficile is a common cause of diarrhoea, especially diarrhoea associated with a history of antibiotic use [1]. C. difficile has been identified as the major pathogen implicated in nosocomial diarrhoea arising >72 hours after admission among patients receiving antibiotics [2]. Risk factors for C. difficile infection (CDI) include antibiotic exposure, hospitalisation, and advanced age [1]. In North America and Europe, the epidemiology of CDI is well-documented
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