"Clostridium difficile associated pseudomembranous colitis: An under-recognized threat" - Scenario from a Tertiary Care Hospital

This is regarding one article by Vaishnavi et al. “clinical and demographic profile of patients reporting for Clostridium difficile infection (CDI) in a Tertiary Care Hospital”.[1] We had a similar experience in a Tertiary Care Hospital for the time period of 10.5 years starting from January 2005 to May 2015, where we received 716 faecal samples for diagnosing CDI by the qualitative detection of C. difficile toxin (CDT) A and B using RIDASCREEN CDT A/B (C0801) kit with a sensitivity of 89.7%, specificity of 96.8%, positive predictive value of 81.3% and negative predictive value of 98.4%. The results obtained by us were different from the above-mentioned study. In our study, CDT A/B was detected in 7.40% (n = 53) faecal samples. Among CDT-positive patients, 67.92% were males and 32.08% were females. In age-wise distribution, infant (0–2 years), paediatric group (>2–18 years), adult group (>18–60 years) and geriatric group (>60 years); prevalence of CDT positivity was 1.89%, 5.66%, 35.85% and 56.60%, respectively. Prevalence of CDT in patients with clinical condition was similar to the above mentioned study: gastrointestinal diseases (28.30%), renal diseases (26.42%), surgical conditions (18.87%), hepatic disorders (13.21%), cancers (9.43%) and blood diseases (3.77%). The majority of these patients were on antibiotics such as cephalosporins, aminoglycosides, fluoroquinolones, glycopeptides, carbapenems and chloramphenicol. Some patients also received antifungal therapy (26.42%) and steroids (28.80%). We also looked in patients with CDT positivity for the presence of various predisposing risk factors; percentage prevalence of patients with co-morbidities such as diabetes mellitus type 2, chronic kidney disease, hypertension was 64.07%, age >50 years in 57.50%, compromised immunity in 31.15%, frequent hospitalisation in 58.85%, intake of >3 antibiotics in 95.66% and administration of proton pump inhibitors in 98.85%. The difference in the prevalence of CDT positivity between the two studies mentioned seems to be due to the huge difference in sample size. The prevalence of CDT positivity reported by other authors in the past varied from 11% to 22%.[2-5]