title: Clostridium difficile as a cause of acute diarrhea: a prospective study in a tertiary care center.
abstract: BACKGROUND
  Clostridium difficile-associated diarrhea (CDAD) is an increasing problem. Recent reports suggest presence of community acquired CDAD (CA CDAD). Studies in India have shown varied results.
  
  
  OBJECTIVE
  The following are the aims of this study: (a) the prevalence of CDAD and CA CDAD in patients with acute diarrhea; (b) the incremental yield of second stool sample for the diagnosis of C. difficile infection (CDI); and (c) the risk factors for CDI.
  
  
  METHODS
  Patients with acute diarrhea (<4 weeks) between April 2009 and December 2010 had two stool sample tested for C. difficile toxin (CDT) by enzyme-linked immunofluorescent assay. Demographic, clinical data, risk factors, clinical course, complications, treatment, and response were noted.
  
  
  RESULTS
  Of 150 patients (mean age, 47.3 years; 76 males), 12 (8 %) had their first stool sample positive for CDT. Two patients (1.3 %) had community acquired CDI. The study group was compared with 138 patients ("control group", stool samples negative for CDT). Compared to the controls, the study group were more likely to have had intensive care unit (ICU) stay (p = 0.018) and tube feeding (p = 0.035). Eleven patients were treated with metronidazole. One patient did not respond to metronidazole and was treated with vancomycin. No patient developed complications of CDAD.
  
  
  CONCLUSIONS
  The prevalence of CDAD in our population was 8 % and of CA CDAD was 1.3 %. There was no advantage of testing two samples. ICU stay and tube feeding were major risk factors for the CDAD. Metronidazole was an effective first-line therapy.
authors.affiliation: Division of Gastroenterology, P D Hinduja National Hospital and Medical Research Center, Veer Savarkar Marg, Mahim West, Mumbai 400 016, India.
authors.forename: Meghraj
authors.initials: M
authors.lastname: Ingle
authors.forename: Abhijit
authors.initials: A
authors.lastname: Deshmukh
authors.forename: Devendra
authors.initials: D
authors.lastname: Desai
authors.forename: Philip
authors.initials: P
authors.lastname: Abraham
authors.forename: Anand
authors.initials: A
authors.lastname: Joshi
authors.forename: Tarun
authors.initials: T
authors.lastname: Gupta
authors.forename: Camilla
authors.initials: C
authors.lastname: Rodrigues
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D003967:Diarrhea / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D055815:Young Adult