The Prevalence of Clostridium difficile Infection in a Cohort of Sri Lankan Patients with Acute Severe Ulcerative Colitis

Abstract

Introduction: Global studies report that 5%-19% of patients with acute severe ulcerative colitis (ASUC) are positive for Clostridium difficile. Data from Sri Lanka, as well as from other countries in South Asia are lacking. Guidelines recommend all patients with ASUC be tested for Clostridium difficile in stools. The implications of this on developing countries such as ours are a higher cost to patients. Therefore in this study we sort to find out the prevalence of Clostridium difficile infection in patients with ASUC presenting to a teaching hospital over an eighteen month period. Method: All ulcerative colitis (histologically proven) patients admitted with ASUC from July 2011 to December 2012 were included. ASUC was diagnosed according to True love and Witt's criteria. A Clostridium difficile infection was diagnosed based on the ELISA test to detect Clostridium difficile toxins, done on a single sample of stools within 24 hours of admission. Results and discussion: 32 patients; with ASUC were included. Six (18.75%) tested positive for Clostridium difficile. The mean age was 28 and 48 years in the positive and negative group respectively. Of the positive patients three were previously on Aminosalicylates and three were treatment naive. Apart from one patient with a history of recent antibiotic use, none of the other patients gave a history of antibiotic, PPI use or hospital admission within 3 months. The White blood cell count, ESR or stools full report were unable to predict the presence of Clostridium difficile infection. Apart from one patient with pseudo-membranes on endoscopy, none of the other toxin positive patient's endoscopy or histology was suggestive of Clostridium difficile infection. Conclusion: This study shows a high prevalence of Clostridium difficile infection among Sri Lankan patients presenting with ASUC, which is in keeping with studies reported previously. Although local or regional guidelines are lacking, this study also reconfirms the necessity to test for Clostridium difficile in ASUC. As suggested by previous authors the risk factors associated with the development of Clostridium difficile infections in ASUC seems different to the general population.