Methods: This was a prospective observational cohort study at two large tertiary care centers in Dhaka, Bangladesh, conducted from 01/2017 to 12/2017. Stool samples were collected from hospitalized adults with diarrhea (≥3 loose stools in a 24-hour period) and antimicrobial exposure within the past 30 days. Hospital environmental samples were collected by swabbing surfaces of common areas in the hospital. All samples underwent toxigenic culture. C. difficile isolates were tested for toxins A and B and PCR-ribotyped.
Results: Of 204 stool samples collected, 16 (7.8%) were positive for toxigenic C. difficile. Patients with CDI shared a room with significantly more patients (Table 1). Of 392 environmental samples, 48 (12.2%) were positive for toxigenic C. difficile, which was more common in patient care versus non-patient care areas (14.4% vs 7.8%, p = 0.057). Twelve clinical stool isolates and 42 environmental isolates were ribotyped. Ribotypes identified in stool isolates were F017 (50%), FP053-163 (17%), FP435 (17%), F106 (8%), and F014-020 (8%). With the exception of FP435, these were also the most common ribotypes in environmental isolates: F017 (24%), FP053-163 (12%), F106 (26%), and F014-020 (10%).
Conclusion: For the first time, we report the prevalence of CDI and ribotypes in at risk patients in Bangladesh. Rates and ribotypes are similar to other resource-rich or resource-limited countries.
Table 1. Demographic data for all stool samples
|Variable||No toxigenic C. difficile (n=188)||Toxigenic C. difficile (n=16)||p|
|Female sex, n (%)||77 (41)||9 (56)||0.234|
|Age, years, median (IQR)||46 (32-58)||39 (25-53)||0.212|
|Hospital A, n (%)||149 (79)||13 (81)||>0.99|
|Length of prior hospital stay, days, median (IQR)||13 (7-23)||14 (8-32)||0.798|
|Duration of previous antibiotics, days, median (IQR)||10 (7-17)||12 (6-20)||0.687|
|Number of patients in the same room, median (IQR)||13 (7-19)||19 (14-20)||0.009|
A. K. Sofjan,
M. A. Islam, None
K. W. Garey, Merck & Co.: Grant Investigator , Grant recipient .