title: Hospital-acquired Clostridium difficile infection among patients with type 2 diabetes mellitus in acute medical wards.
abstract: BACKGROUND
  Clostridum difficile (C. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. We aimed to determine the rate and characteristics of hospital-acquired C. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards.
  
  
  METHODS
  Our prospective cross-sectional study involved 159 patients with established type 2 diabetes mellitus admitted into acute medical wards who developed a hospital-acquired C. difficile infection. Stools were tested for C. difficile toxins using a toxin A/B kit and a toxin A kit. Clinical features, laboratory findings, types of antibiotics, and use of a proton pump inhibitor were examined for their association with the infection.
  
  
  RESULTS
  Thirteen subjects were positive for toxin A and one for toxin B. Using univariable analysis, we found that patients with type 2 diabetes mellitus and hospital acquired C. difficile infection were younger (mean 53.8 years, p=0.02), had diarrhoea and abdominal pain (p=0.001) but no fever. Sepsis (p=0.02) and use of a proton pump inhibitor (p=0.01) were more commonly implicated as the cause of the infection. Of the various types of antibiotics prescribed, carbapenem (28.6% vs 4.1%, p=0.01) and metronidazole (42.9% vs 19.3%, p=0.04) were significantly associated with hospital acquired C. difficile infection.
  
  
  CONCLUSIONS
  Patients with type 2 diabetes mellitus admitted into acute medical wards and who developed hospital-acquired C. difficile infection have distinct characteristics.
authors.affiliation: Department of Medical Microbiology and Parasitology, Universiti Sains Malaysia, Kelantan, Malaysia. justnleeyy@gmail.com
authors.forename: S A
authors.initials: SA
authors.lastname: Hassan
authors.forename: R A
authors.initials: RA
authors.lastname: Rahman
authors.forename: N
authors.initials: N
authors.lastname: Huda
authors.forename: W M
authors.initials: WM
authors.lastname: Wan Bebakar
authors.forename: Y Y
authors.initials: YY
authors.lastname: Lee
mesh_terms: D015746:Abdominal Pain / Q000139:chemically induced; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001426:Bacterial Proteins / Q000032:analysis; D001427:Bacterial Toxins / Q000032:analysis; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000139:chemically induced* / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D003967:Diarrhea / Q000139:chemically induced; D004768:Enterotoxins / Q000032:analysis; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000009:adverse effects*; D018805:Sepsis / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D004768:Enterotoxins; D054328:Proton Pump Inhibitors; C041348:tcdA protein, Clostridium difficile; C031815:toxB protein, Clostridium difficile; D008795:Metronidazole
keywords: Clostridium difficile; acute medical wards; antibiotics; nosocomial; type 2 diabetes mellitus