338. Prevalence, Risk Factors, and Outcome of Clostridium difficile-associated Diarrhea in a University Hospital in Thailand
Session: Poster Abstract Session: Clostridium difficile - Epidemiology, Diagnosis, Treatment, and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
  • IDSA poster3.pdf (116.9 kB)
  • Background: 

    An increase in incidence and severity raises a concern on C. difficile associated-diarrhea (CDAD). Due to low sensitivity of stool C. difficile toxin enzyme immunoassays (EIA), the CDAD prevalence might be underestimated. Decreasing efficacy of metronidazole for CDAD treatment has been reported but it is not clear in Thailand. This study aims to investigate the prevalence of CDAD in patients with nosocomial diarrhea by EIA for toxins A and B and PCR for the tcdB gene from stool samples and to determine associated-factors as well as treatment outcome of CDAD.


    A prospective cohort study was conducted from May 2010 through January 2011 in adult patients who developed diarrhea while stayed in medicine ward or shortly after discharged from a hospital. A total of 175 episodes were included and tested by EIA and PCR. Diarrheal episodes were categorized as CDAD case, if either one or both of these tests were positive.


    The prevalence of positive CDAD was 26.9%; 12.6% by EIA and 24.0% by PCR. The kappa coefficient and total agreement of both tests was 0.46 and 83.2%, respectively. Most cases of diarrhea occurred after the admission. There were no differences in gender, age, comorbidities, hospital stay duration, recent surgery, intensive care unit stay, and use of antibiotics, proton pump inhibitors, immunosuppressants, and nasogastric tube between CDAD and non CDAD cases. The median duration from the receipt of antibiotics to diarrhea onset was significantly longer in CDAD cases (14 vs. 8 days; p=0.003). Multivariate analysis found diarrhea onset after ≥10 days of recent antibiotic receiving (OR 2.71; 95% CI, 1.14-6.44; p=0.024) and WBC >15,000 cells/mm3 (OR 3.12; 95% CI, 1.24-7.88; p=0.016) were significantly associated with CDAD case. The non-response rate to CDAD treatment was 24.1% and all-cause mortality was 31.9% in CDAD vs. 35.9% in non CDAD group (p=0.721).


    Prevalence of CDAD tended to increase. Our direct stool PCR for tcdB showed higher positive results compared to stool toxin A&B EIA. Patients who develop diarrhea after admission and receive antibiotic ≥10 days or have high WBC > 15,000 cells/mm3 should be investigated for CDAD.

    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Darunee Chotiprasitsakul, MD1, Kumthorn Malathum, MD2, Tavan Janvilisri, PhD3, Sasisopin Kiertiburanakul, MD, MHS1, Siriorn Watcharananun, MD1, Surang Chankhamhaengdecha, PhD3 and Piyapong Hadpanus, BSc3, (1)Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, (2)Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand, (3)Department of Biology, Faculty of Science, Mahidol University, Bangkok, Thailand


    D. Chotiprasitsakul, None

    K. Malathum, None

    T. Janvilisri, None

    S. Kiertiburanakul, None

    S. Watcharananun, None

    S. Chankhamhaengdecha, None

    P. Hadpanus, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.