Prevalence and Clinical Features of Clostridioides difficile Infections among Inpatients in a Tertiary Care Teaching Hospital: A Retrospective Cross-sectional Study from Southern India

Abstract

Introduction: Clostridioides difficile (C. difficile), once considered a nosocomial pathogen, is now increasingly being observed in the community. The organism is known to cause Antibiotic-associated Diarrhoea (AAD), Pseudomembranous Colitis (PMC), megacolon, and even death. Aim: To determine the prevalence of C. difficile in stool samples and to associate the findings with the clinical presentation and risk factors of the patients. Materials and Methods: This retrospective cross-sectional study analysed 208 stool samples received for C. difficile detection at Father Muller Medical College Hospital, Mangaluru, Karnataka, India from January 2021 to January 2023 using the CerTest C. difficile Glutamate dehydrogenase (GDH)+ Toxin A+B onestep combo card test. The results were then associated with the clinical profiles of the patients retrieved from the hospital software, Backbone. Statistical analysis was performed using frequency, percentage, the Chi-square test, and the z-test. Results: Out of the 208 samples analysed from patients belonging to all ages, 20 samples (9.62%) harboured toxigenic C. difficile, while 22 samples (10.58%) contained non toxigenic C. difficile. Proton Pump Inhibitor (PPI) use and underlying diseases/conditions were identified as highly significant risk factors (χ2=32.28, p-value<0.001, HS) among patients with toxigenic C. difficile. AAD was found to be statistically significant (p-value=0.030, Sig) in toxigenic patients compared to those with non toxigenic C. difficile. Conclusion: The increasing presence of C. difficile in our community is a matter of concern. Continuous surveillance, vigilance, and appropriate preventive measures are crucial in mitigating the impact of C. difficile Infections (CDI) in hospitals and in the community.