Hospital-acquired Clostridium difficile infection amongst ICU and burn patients in Kuwait.
OBJECTIVE
To prospectively study the prevalence of nosocomially acquired Clostridium difficile, a major cause of diarrhoea in hospitalized patients, in the intensive care units (ICUs) and burn unit (BUs) of three teaching hospitals in Kuwait.


METHODS
During a 1-year prospective study, stool/rectal swabs were obtained from 344 patients admitted into the ICUs of Mubarak Hospital (ICU-1), the Kuwait Cancer Control Centre (ICU-2), and the BU of Ibn Sina Hospital. The presence of C. difficile and/or its toxin was detected by serially culturing the specimens on differential, selective and enriched media and the use of TOX-A/B test, on admission and at subsequent 1-weekly interval until discharge.


RESULTS
Out of the 344 patients admitted into these units, over a study period of 1 year, only 263 (77%) were evaluable. All of them had negative stool culture/toxin on admission. Overall, 25 (9.5%) of these 263 patients acquired C. difficile during their hospitalization. Thirteen (7%) of 187 patients acquired C. difficile in ICU-1, 9 (36%) of 25 on ICU-2 and 3 (5.9%) of 51 patients in BU. Eight (32%) developed diarrhoea attributable only to C. difficile and/or toxin, and the remaining 17 (68%) were asymptomatic: none had pseudomembranous colitis. The diarrhoea in these patients was associated with antibiotic use, the main trigger-antibiotics being the third-generation cephalosporins. Acquisition occurred within 4-53 days of admission, with the majority occurring in the first 15 days.


CONCLUSIONS
Overall, the prevalence of hospital-acquired C. difficile infection/colonization was less than 10%. The use of third-generation cephalosporins was high and was related to the development of diarrhoea. Once acquired, diarrhoea developed in about one third of C. difficile-positive cases, an indication that C. difficile infection/colonization endemic in the hospital ICUs studied is usually transmitted among the hospitalized patients.
Rotimi
V O
VO
Department of Microbiology, Faculty of Medicine, Kuwait University, PO Box 24923, 13110 Safat, Kuwait.
Mokaddas
E M
EM
Jamal
W Y
WY
Verghese
T L
TL
el-Din
K
K
Junaid
T A
TA
D000293:Adolescent; D000328:Adult; D002053:Burn Units / Q000706:statistics & numerical data*; D002056:Burns / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D015897:Comorbidity; D003428:Cross Infection / Q000453:epidemiology*; D003967:Diarrhea / Q000382:microbiology; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D017757:Infectious Disease Transmission, Professional-to-Patient; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007730:Kuwait / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013997:Time Factors