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Background: Clostridium difficile (C. difficile) is a spore-forming, toxin-producing,
gram-positive anaerobic bacterium. It is the leading cause of nosocomial diarrhoea. C.
difficile-associated diarrhoea (CDAD) is one of the most common healthcareassociated
infections and a significant cause of morbidity and mortality among
hospitalized patients. The prevalence rate of C. difficile infection/carriage in sub-
Saharan Africa has been reported to range from 4.9 – 43%. Despite widespread access
to over-the-counter antibiotics in Kenya coupled with high rates of nosocomial
diarrhoea, patients are not tested for CDAD due to presumptions of low prevalence
and technical inaccessibility.
Objective: To determine the prevalence and describe the characteristics of patients
with Clostridium difficile-associated diarrhoea (CDAD) at Moi Teaching and Referral
hospital (MTRH), Eldoret, Kenya.
Methods: In this cross-sectional study, 110 unformed stool samples were taken from
the participants who were admitted and developed diarrhoea after 48 hours of
antibiotic use or admitted with diarrhoea with a history of antibiotics use in the last 30
days. The samples were tested for C. difficile toxin B and the hypervirulent strain
(027/NAP1/BI strain) by using the Cepheid GeneXpert® molecular method.
Participants‟ age, sex and clinical characteristics were analysed using Chi-square test,
Fisher‟s exact test and Wilcoxon rank sum test. A p value <0.05 was considered to be
statistically significant.
Results: One hundred and ten participants provided stool samples, of which 104 had
valid PCR results. A majority (57.7%) of the participants were female with a median
age of 39.5 years (IQR 25). CDAD was diagnosed in 23 (22.2% (95% CI 14.0- 30.2))
of the 104 participants whereas the hypervirulent strain was not detected in any of the
samples. The median age of participants with CDAD was 42 years (IQR, 22) and 13
out of the 23 (56.5%) were female. There was a statistically significant association of
CDAD with, prolong duration of hospitalization (p=0.02, Wilcoxon ranksum test);
prolonged exposure to antibiotics ≥1 week (p=0.031, Fisher‟s exact test); exposure to
>1 antibiotic (p=0.004, Fisher‟s exact test) and admission to surgical ward (p=0.01,
Fisher‟s exact test). Both univariate and multivariate analysis showed that use of >1
antibiotic (OR, 3.3; 95% CI, 1.03-10.01; p= 0.04) was significantly associated with
CDAD.
Conclusion: CDAD is present in our setting, with a prevalence of 22.2%. CDAD is
significantly associated with long duration of hospitalization, history of prolonged
antibiotic exposure and use of multiple antibiotics.
Recommendation: The diagnosis of C. difficile and testing for C. difficile toxins
should be considered in persons who develop diarrhoea after history of antibiotic use. |
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