A study on the prevalence of clostridium difficile infection and associated risk factors in large hospital settings in Kota Kinabalu, Sabah

• Main Author: Nur Nashyiroh Izayati Mastor
• Format: Thesis
• Language: English
• Published: 2018
• Subjects: R Medicine (General)
• Online Access: https://eprints.ums.edu.my/id/eprint/25125/1/A%20study%20on%20the%20prevalence%20of%20clostridium%20difficile%20infection%20and%20associated%20risk.pdf; https://eprints.ums.edu.my/id/eprint/25125/

Clostridium diffidle is a gram positive anaerobic bacterium and has emerged as a global public health problem especially in hospitalized patients. The prevalence rate of Gostridium difficile infection (CDI) varies among different regions of the world. C diffidle can be found in soil, water and faeces and it is naturally present in normal healthy human intestine. COi is transmitted via faecal-oral route and by contact with the stool of infected patient or through healthcare workers. There have been only a few studies reported from Asia Pacific countries including Malaysia. Antibiotic is the predominant risk factor for CDI other than advanced age, comorbidities and length of hospitalization. The aim of the present study was to determine the prevalence and risk factor associated with CDI among hospitalized patients in a large tertiary hospital in Sabah, Malaysia. A total number of 1475 stool suspected for CDI from two hospital in Kota Kinabalu Sabah were tested with two commercial rapid diagnostic test kits; (1) C. DIFF QUIK CHEK COMPLETE (Alere, Techlab, USA) and (2) DUO TOXIN A&B (VEDA Lab, France) according to manufacturer's protocol. Adult and children stool samples were taken from Queen Elizabeth Hospital and Women and Children Hospital Kata Kinabalu Sabah Malaysia from January 2016 to May 2018. The patient's age range from 1 to 97 years old. The demographic data and other dinical information were obtained from hospital medical record and analysed using a standard questionnaire base on Bauer MP et al (2011). In this present study, we found that the overall prevalence of adult COi was 4.6% (57 /1226). There were 35.7% (20/56) of the positive adult CDI patients belong to more than 65 years of age group. Results from C. DIFF QUIK CHEK COMPLETE (Alere,Techlab,USA) showed 14 positive cases were either antigen or toxin positive. The rate of antigen positivity was 17.5% and toxin positivity was 82.5%. Stool tested with DUO TOXIN A&B test kit indicated 57 .9% toxin B positivity, 10.5% toxin A&B and 1.8% toxin A. Out of examined patients 56.8% were male and 87 .7% of the study population had prior history of antibiotic uses and comorbidity was reported 64.1%. Recurrence rate was 14.3%. For children data, we observed 80 of the 249 stool samples were positive either C diffiale antigen and/or toxin. The overall incidence was 32.1%.The rate of antigen positivity was 86.25% and toxin positivity was 13.75%. The median age of the studied children was 6 years. Similar with adult COi patients, children female patients are more common diagnosed with COi in our study compare to male children. Most of the test positive children were colonized with non-toxigenic C diffidle. The recurrence rate was 11.25%. In condusion, the total prevalence was 93% and we observed low incidence of toxigenic C diffiale among hospitalized adult and children patients from the two hospitals during the study period. The findings of this study suggest that long-term surveillance is needed to understand the epidemiology of the dangerous emerging pathogen and control the infections in hospital and community.