Analysis of Clostridioides difficile infection characteristics and risk factors in patients hospitalized for diarrhea in 3 university hospitals in a mid-south city of China

doi:10.12122/j.issn.1673-4254.2024.05.23

Abstract

Abstract:

Objective To investigate the characteristics of Clostridioides difficile infection (CDI) in patients hospitalized for diarrhea and analyze the risk factors for CDI. Methods Stool samples were collected from 306 patients with diarrhea hospitalized in 3 university hospitals in a mid-south city of China from October to December, 2020. C. difficile was isolated by anaerobic culture, and qRT-PCR was used to detect the expressions of toxin A (tcdA) and B(tcdB) genes and the binary toxin genes (cdtA and cdtB). Multilocus sequence typing (MLST) was performed for the isolated strains without contaminating strains as confirmed by 16S rDNA sequencing. Etest strips were used to determine the drug resistance profiles of the isolated strains, and the risk factors of CDI in the patients were analyzed. Results CDI was detected in 25 (8.17%) out of the 306 patients. All the patients tested positive for tcdA and tcdB but negative for the binary toxin genes. Seven noncontaminated C. difficile strains with 5 ST types were isolated, including 3 ST54 strains and one strain of ST129, ST98, ST53, and ST631 types each, all belonging to clade 1 and sensitive to metronidazole and vancomycin. Hospitalization within the past 6 months (OR=3.675; 95% CI: 1.405-9.612), use of PPIs (OR=7.107; 95% CI: 2.575-19.613), antibiotics for ≥1 week (OR=7.306; 95% CI: 2.274-23.472), non-steroidal anti-inflammatory drugs (OR=4.754; 95% CI: 1.504-15.031) in the past month, and gastrointestinal disorders (OR=5.050; 95% CI: 1.826-13.968) were all risk factors for CDI in the patients hospitalized for diarrhea. Conclusion The CDI rate remains low in the hospitalized patients with diarrhea in the investigated hospitals, but early precaution measures are recommended when exposure to the risk factors is reported to reduce the risk of CDI in the hospitalized patients.

Key words: Clostridioides difficile, toxin gene, multilocus sequence typing, drug resistance, risk factors

Yong ZHOU, Yuan WU, huiwen ZENG, Cuimei CHEN, Qun XIE, Liping HE. Analysis of Clostridioides difficile infection characteristics and risk factors in patients hospitalized for diarrhea in 3 university hospitals in a mid-south city of China[J]. Journal of Southern Medical University, 2024, 44(5): 998-1003.

Figures/Tables 4

References 32

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Type of antibiotics	Name of antibiotics	Number of resistant strains (n)
Type of antibiotics	Name of antibiotics	ST54	ST129	ST98	ST53	ST631	Total
Glycopeptides	VAN	0	0	0	0	0	0
Nitroimidazoles	MTZ	0	0	0	0	0	0
Rifamycins	RIF	0	0	0	1	0	1 (1/7)
Fluoroquinolones	MXF	0	0	0	1	1	2 (2/7)
Tetracyclines	TET	0	0	0	0	1	1 (1/7)
Carbapenems	MEM	0	0	0	0	1	1 (1/7)
Phenylpropanols	CHL	0	0	0	0	1	1 (1/7)
Macrolides	ERY	3	0	1	1	1	6 (6/7)
	CLI	3	0	1	1	1	6 (6/7)

Type of antibiotics	Name of antibiotics	Number of resistant strains (n)
Type of antibiotics	Name of antibiotics	ST54	ST129	ST98	ST53	ST631	Total
Glycopeptides	VAN	0	0	0	0	0	0
Nitroimidazoles	MTZ	0	0	0	0	0	0
Rifamycins	RIF	0	0	0	1	0	1 (1/7)
Fluoroquinolones	MXF	0	0	0	1	1	2 (2/7)
Tetracyclines	TET	0	0	0	0	1	1 (1/7)
Carbapenems	MEM	0	0	0	0	1	1 (1/7)
Phenylpropanols	CHL	0	0	0	0	1	1 (1/7)
Macrolides	ERY	3	0	1	1	1	6 (6/7)
	CLI	3	0	1	1	1	6 (6/7)

Factor	Infected group (n=25)	Non-infected group (n=281)	χ²/t	P
Gender
Male	15 (60.0%)	178 (63.3%)	0.110	0.740
Female	10 (40.0%)	103 (36.7%)
Age (year)
≥60	16 (64.0%)	112 (39.9%)	5.499	0.019
<60	9 (36.0%)	169 (60.1%)
Length of hospitalization	11 (8-15)	10 (6-13)	z=1.366	0.172
Hospitalization within the past half year
Yes	14 (56.0%)	83 (29.5%)	7.425	0.006
No	11 (44.0%)	198 (70.5%)
Use of PPIs within the past month
Yes	17 (68.0%)	92 (32.7%)	12.446	<0.001
No	8 (32.0%)	189 (67.3%)
Use of glucocorticoids within the past month
Yes	11 (44.0%)	49 (17.4%)	10.276	0.001
No	14 (56.0%)	232 (82.6%)
Use of insulin within the past month
Yes	3 (12.0%)	19 (6.8%)	0.332	0.570
No	22 (88.0%)	262 (93.2%)
Use of immunosuppressants within the past month
Yes	3 (12.0%)	47 (16.7%)	0.109	0.741
No	22 (88.0%)	234 (83.3%)
Use of antibiotics within the past month
Not used	5 (20.0%)	148 (52.7%)	12.762	0.002
Used for<1 week	3 (12.0%)	40 (14.2%)
Used for≥1 week	17 (68.0%)	93 (33.1%)
Use of non-steroidal anti-inflammatory drugs within the past month
Yes	7 (28.0%)	29 (10.3%)	6.913	0.009
No	18 (72.0%)	252 (89.7%)
History of gastrointestinal surgery
Yes	6 (24.0%)	32 (11.4%)	3.358	0.067
No	19 (76.0%)	249 (88.6%)
Underlying disease
Diabetes	4 (16.0%)	28 (10.0%)	0.365	0.546
Malignancy	4 (16.0%)	41 (14.6%)	0.000	1.000
Nervous system disorders	4 (16.0%)	54 (19.2%)	0.016	0.899
Cardiovascular diseases	5 (20.0%)	49 (17.4%)	0.002	0.961
Gastrointestinal diseases	11 (44.0%)	49 (17.4%)	8.660	0.003
Hepatobiliary diseases	9 (36.0%)	42 (14.9%)	5.889	0.015

Factor	Infected group (n=25)	Non-infected group (n=281)	χ²/t	P
Gender
Male	15 (60.0%)	178 (63.3%)	0.110	0.740
Female	10 (40.0%)	103 (36.7%)
Age (year)
≥60	16 (64.0%)	112 (39.9%)	5.499	0.019
<60	9 (36.0%)	169 (60.1%)
Length of hospitalization	11 (8-15)	10 (6-13)	z=1.366	0.172
Hospitalization within the past half year
Yes	14 (56.0%)	83 (29.5%)	7.425	0.006
No	11 (44.0%)	198 (70.5%)
Use of PPIs within the past month
Yes	17 (68.0%)	92 (32.7%)	12.446	<0.001
No	8 (32.0%)	189 (67.3%)
Use of glucocorticoids within the past month
Yes	11 (44.0%)	49 (17.4%)	10.276	0.001
No	14 (56.0%)	232 (82.6%)
Use of insulin within the past month
Yes	3 (12.0%)	19 (6.8%)	0.332	0.570
No	22 (88.0%)	262 (93.2%)
Use of immunosuppressants within the past month
Yes	3 (12.0%)	47 (16.7%)	0.109	0.741
No	22 (88.0%)	234 (83.3%)
Use of antibiotics within the past month
Not used	5 (20.0%)	148 (52.7%)	12.762	0.002
Used for<1 week	3 (12.0%)	40 (14.2%)
Used for≥1 week	17 (68.0%)	93 (33.1%)
Use of non-steroidal anti-inflammatory drugs within the past month
Yes	7 (28.0%)	29 (10.3%)	6.913	0.009
No	18 (72.0%)	252 (89.7%)
History of gastrointestinal surgery
Yes	6 (24.0%)	32 (11.4%)	3.358	0.067
No	19 (76.0%)	249 (88.6%)
Underlying disease
Diabetes	4 (16.0%)	28 (10.0%)	0.365	0.546
Malignancy	4 (16.0%)	41 (14.6%)	0.000	1.000
Nervous system disorders	4 (16.0%)	54 (19.2%)	0.016	0.899
Cardiovascular diseases	5 (20.0%)	49 (17.4%)	0.002	0.961
Gastrointestinal diseases	11 (44.0%)	49 (17.4%)	8.660	0.003
Hepatobiliary diseases	9 (36.0%)	42 (14.9%)	5.889	0.015

Factor	Infected group (n=25)	Non-infected group (n=281)	χ²/t	P
Clinical symptoms
Abdominal pain	11 (44.0%)	79 (28.1%)	2.791	0.095
Watery stools	10 (40.0%)	88 (31.3%)	0.795	0.373
Vomiting	5 (20.0%)	47 (16.7%)	0.174	0.676
Fever	6 (24.0%)	46 (16.4%)	0.947	0.330
Occult blood	7 (28.0%)	33 (11.7%)	5.339	0.021
Laboratory tests
White blood cell count (×10⁹/L)	8.55±2.55	8.71±2.52	0.298	0.766
Serum C-reactive protein (mg/L)	22.20±17.62	20.45±14.45	0.304	0.571
Procalcitonin (PCT, ng/mL)	0.38±0.12	0.32±0.16	1.957	0.051
Blood sodium (mmol/L)	139.3±3.5	142.1±7.7	1.840	0.067