Study of Clostridioides Difficile Associated Diarrhea in Acute Care Areas of a Tertiary Care Centre in Western Rajasthan- A Prospective Study

Purpose: The aim of this study is to identify Clostridioides difficile associated diarrhoea (CDAD) in patients admitted to acute care units of the hospital. It also examines different detection methods, including anaerobic culture, GDH assay, and Toxin A/B ELISA, while exploring how the infection relates to patient risk factors and clinical features. Materials and Method: Cross sectional study conducted in the Department of microbiology over 2 years. Patients >1 year of age, who were admitted and passing atleast 3 unformed stool over 24 hours, with history of taking antibiotics were included in the study. Stool samples from the included patients were collected, with one part used for anaerobic culture and another part for serological testing using Glutamate Dehydrogenase (GDH) ELISA and Toxin A/B ELISA for C. difficile. Identification of isolates was performed using MALDI-TOF MS. The results were analysed using statistical methods. Result: Out of 180 suspected cases of Antibiotic Associated Diarrheal (AAD), 95(52.8%) were males. Maximum cases were in age group, above 60 years (27.8%) & 51 to 60 years (15.6%). Out of the 180 samples, GDH ELISA was positive in 29 (16%) cases, however Toxin A/B ELISA was positive in 5 (2.8%) samples. Thus, the prevalence of CDAD was found to be 2.8%. Isolation of Clostridioides difficile from culture was in 3 (1.7%) cases. 80% of confirmed CDAD cases were received more than one antibiotic. The median antibiotic duration among CDAD cases was 14 days (IQR = 9). All CDAD cases had a history of consumption of BL-BLI antibiotics, while 40% were on Meropenem, and 20% were on Ceftriaxone and Levofloxacin antibiotics. A possible association between abdominal surgery and CDAD was also noted in the study. Mortality rate in confirmed CDAD cases was 60%. Conclusion: This study in Western Rajasthan underscores the paramount importance of early CDAD detection and management to forestall fatal complications and mortality in critically ill patients, while fostering prudent antibiotic utilization and fortifying antimicrobial stewardship practices in hospital setting.