ABSTRACT
Aim: This study evaluated the frequency of C. difficile and CDAD in the ICU of Shahid Bahonhar Hospital, Kerman, Iran
Background: Clostridium difficile [C. difficile] is the most important antibiotic associated diarrhea agent in intensive care unit [ICU] patients. Based on its toxin producing ability, C .difficile is divided to toxigenic and non-toxigenic strains
Methods: A total of 233 diarrheal samples were collected from ICU patients. The samples were cultured on Clostridium difficile medium with 5% defibrinated sheep blood containing cycloserine [500 mg/L], cefoxitin [16 mg/L] and lysozyme [5mg/L]. The isolates were confirmed as C. difficile by polymerase chain reaction [PCR] of 16s rRNA gene and the presence of toxins genes [tcdA, tcdB, cdtA and cdtB] was also confirmed. Then, the toxin production of isolates was evaluated using ELISA
Results: C. difficile was isolated from 49 [21%] out of 233 samples. The total isolates fell into the A-/B-/CDT- [48.97%], A+/B- /CDT- [28%], A+/B+/CDT- [20.4%] and A+/B+/CDT+ [2%] types. Both types of C.difficile, A-/B-/CDT- and A+/B-/CDT-, which account for 77.5% of all isolates, were unable to produce the toxin [nontoxigenic]. On the other hand, A+/B+/CDT+ and A+/B+/CDT- [22.5%], were able to produce toxin or were toxigenic
Conclusion: The frequency of C. difficile was about 21% and only 22.4% of C. difficile isolates were able to produce toxins. It is expected that C. difficile A+/B+/CDT+- are toxigenic and related to C. difficile associated diarrhea [CDAD]. Additionally, about 4.7% of hospitalized patients in ICU suffered from CDAD, which is higher than the rates reported from industrialized countries. Notably, 28% of isolates were C. difficile A+/B-/CDT- which only carries tcdA genes without toxin production