MOLECULAR CHARACTERIZATION OF CLOSTRIDIUM DIFFICILE TOXIGENIC STRAINS AND ANTIBIOTIC SUSCEPTIBLY PATTERNS AMONG PALESTINIANS IN PARTS OF NORTH WEST BANK
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Date
2023-10-01
Authors
Deema Rasim Khouli
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Abstract
Abstract
Introduction: Clostridium difficile is a Gram-positive, spore-forming bacillus that causes gastrointestinal sickness C. difficile infections (CDIs). C. difficile infection is considered as an opportunistic infection that develops after spores are acquired by fecal-oral route, and germinate into vegetative cells, start producing virulent toxins (A, B, and binary) that are responsible in symptoms and clinical presentation of the infection. Inflammatory diarrhea is the main manifestation among infected patients. It can be moderate and self-limiting, but it can also be severe and lead to serious complications, such as toxic megacolon and pseudomembranous colitis. Irrational use of broad-spectrum antibiotics, age above 65 years, lengthy hospital stays, and immunocompromised state, are the main risk factors for infection Objectives: This study aimed to molecularly characterize toxigenic C. difficile strains, find the prevalence of C. difficile and associated risk factors among Palestinians in the northern part of West Bank, in addition to antibiotic susceptibility pattern against first line choices antibiotics, and finally highlight C. difficile in children population. Methods: A cross- sectional study design was selected, a total stool diarrheal samples collected from patients in governmental hospitals, molecular characterization was done by multiplex PCR and gel electrophoresis, followed by isolation of C. difficile on C. difficile agar base with supplement, antibiotic susceptibility was performed using disk diffusion method on Brucella blood agar supplemented with hemin and vitamin k. Results: The prevalence of C. difficile in prevalence group was 15.7, and incidence of 5.8 per 10,000 diarrhea patient, and prevalence in children group was 10.6. Risk factors in prevalence was antibiotic and PPI use, hospitalization history and comorbidities, in the children group risk factors were antibiotic use and hospitalization history. Isolated toxigenic C. difficile strains was susceptible in 96 %, 89 % against vancomycin and metronidazole respectively. Conclusion: 15.7 prevalence is considered as warning sign, especially when dealing with spore forming bacteria, and CDI in children group, in most cases, masked with amoeba as they result in similar presentation and treated with same antibiotic. Increased awareness about infection prevention practices in hospital and community, in addition to antibiotic stewardship programs are main recommendations to control spread of CDI
Keywords: Clostridium difficile; CDI; Toxins A, B; Binary; diarrhea.