ABSTRACT
To study the frequency of Clostridium difficile in postantibiotic diarrhoea in patients admitted to the medical ward of a secondary care hospital. Observational study. Sindh Government Hospital, Liaquatabad, Karachi, from June 2002 to May 2009. Adults of either gender who received antibiotics after admission and subsequently had watery stools at least 2 days after admission were selected. The exclusion criteria were past history of inflammatory bowel disease or any type of malabsorption state and those who did not show WBCs in stools. All variables of these patients along with clinical findings, type of antibiotic received, and number of stool motions per day were recorded. Three samples of the stools were sent for detailed reports to analyze the number of leukocytes per high field and culture, on cycloserine - cefoxitin - fructose agar [CCFA]. All findings were entered into and analyzed by SPSS 16 for statistical analysis. Out of the 473 patients who received antibiotics for any reasons, 191 [40.38%] developed diarrhoea. The mean age was 45.6 +/- 17.73 years and male to female ratio was 1.85:1. The average number of stools passed per day was 4.84 +/- 1.24 and all patients showed leukocytes in stool samples with a mean count of 6.67 +/- 0.89/HPF. The stool culture on CCFA was positive for 57 patients [29.18%], while 134 patients [70.15%] were stool culture negative as well as negative for evidence of any parasites; these samples were labelled benign antibiotic associated diarrhoea [BAAD]. Ampicillin and amoxicillin with clavulanate were the most implicated antibiotics in this study. Clostridium difficile is the main putative agent in postantibiotic diarrhoea. In settings with limited resources, use of specific culture media such as CCFA proves to be highly cost effective, and sensitive for this diagnosis. Macrolides and quinolones are the safest agents to prescribe in this context