title: Detection of Clostridium difficile diarrhoea in Harare, Zimbabwe.
abstract: BACKGROUND
  Clostridium difficile is associated with nosocomial and community-acquired diarrhoea and pseudomembranous colitis in humans. Little information is available on the importance of C. difficile as a causative agent of diarrhoea in developing countries such as Zimbabwe. The current study was carried out to determine the prevalence of C. difficile in diarrhoeal stools of outpatients over 2 years of age presenting at healthcare centres in Harare, Zimbabwe, and to determine the antimicrobial susceptibility of the isolates.
  
  
  METHODS
  Toxigenic stool culture was used in this study. Diarrhoeal stool specimens were cultured for C. difficile, followed by direct immunoassay on colonies of positive cultures with significant growth to detect toxins A or B.
  
  
  RESULTS
  C. difficile was detected in 8.6% (n=23) of the 268 diarrhoeal stool specimens. All C. difficile isolates were susceptible to metronidazole, vancomycin, chloramphenicol and doxycyline, and resistant to clindamycin, ciprofloxacin, gentamicin and cefotaxime. About 70% of the isolates were resistant to co-trimoxazole.
  
  
  CONCLUSIONS
  C. difficile was observed to be an important diarrhoeal pathogen and metronidazole was effective in treating diarrhoea caused by the bacterium. Co-trimoxazole, which is widely used as prophylaxis against opportunistic infections in HIV/AIDS patients, was not very effective in preventing diarrhoea caused by C. difficile.
authors.affiliation: Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Harare, Zimbabwe cmdsimango@yahoo.com.
authors.forename: Clifford
authors.initials: C
authors.lastname: Simango
authors.affiliation: Department of Medical Laboratory Sciences, College of Health Sciences, University of Zimbabwe, P.O. Box A178, Harare, Zimbabwe.
authors.forename: Steven
authors.initials: S
authors.lastname: Uladi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000187:drug effects* / Q000302:isolation & purification*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D012423:Rural Health; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D055815:Young Adult; D015030:Zimbabwe
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Antimicrobial susceptibility; Clostridium difficile; Diarrhoea; Toxigenic strains, Zimbabwe