Clostridium difficile postantibiotic diarrhoea diagnosis.
OBJECTIVE
To study the frequency of Clostridium difficile in postantibiotic diarrhoea in patients admitted to the medical ward of a secondary care hospital.


METHODS
Observational study.


METHODS
Sindh Government Hospital, Liaquatabad, Karachi, from June 2002 to May 2009.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Medicine and Cardiology, Sindh Government Hospital, Karachi, Pakistan. alihaider1950@gmail.com
Syed Ali
SA
Haider Naqvi
Faisal Fiaz
FF
Chaudhry
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000658:Amoxicillin / Q000009:adverse effects; D000667:Ampicillin / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003967:Diarrhea / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D004359:Drug Therapy, Combination; D005243:Feces / Q000382:microbiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D063127:Secondary Health Care; D017678:Sex Distribution
D000900:Anti-Bacterial Agents; D000667:Ampicillin; D000658:Amoxicillin