Prevalence of Nosocominal Toxigenic Clostridium difficile in Children Under 5 Years in Hajar Hospital, Shahrekord, Iran
Abolfazl Khoshdel1, Karam-Ali Kasiri2, Soleiman Kheiri3, Roya Habibian4, Narges Shojaeikhah5
1 Associate Professor, Clinical Biochemistry Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
2 Assistant Professor, Department of Pediatrics, Shahrekord University of Medical Sciences, Shahrekord, Iran.
3 Associate Professor, Clinical Biochemistry Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran.
4 Associate Professor, Department of Infectious Diseases, Shahrekord University of Medical Sciences, Shahrekord, Iran.
5 General Practitioner, Shahrekord University of Medical Sciences, Shahrekord, Iran.
NAME, ADDRESS, E-MAIL ID OF THE CORRESPONDING AUTHOR: Dr. Karam-Ali Kasiri, Assistant Professor, Department of Pediatrics, Shahrekord University of Medical Sciences, Shahrekord, Iran.
E-mail: kasiri207@yahoo.com
Diarrheal disease is still a main cause of morbidity and mortality in children across the world [1].
Nosocomial diarrhea is a common complication in inpatients [2]. Clostridium difficile is the most common cause of nosocomial diarrheal and antibiotics-associated diarrheal diseases [3–5].
Hospitalization period of patients was from three to 18 days with the mean 5.5±2.21 days. Duration of antibiotic consumption was three to 18 days with the mean 5.4±2.1 days. Diarrhea duration was from one to three days with mean 1.67±0.56 days. The frequency of diseases leading to hospitalization is summarized in [Table/Fig-1].
Causes of hospitalization.
| Disease | Number | Percent |
|---|
| Respiratory tract infection | 124 | 62 |
| Fever without localizing sing | 27 | 13.5 |
| Febrile convulsion | 12 | 6 |
| Urinary tract infection | 5 | 2.5 |
| Total | 200 | 100 |
The types of antibiotic which were administered to children are summarized in [Table/Fig-2].
Types of antibiotic consumption.
| Antibiotic | Number | Percent |
|---|
| Cefotaxime | 102 | 51 |
| Ceftriaxone | 59 | 29.5 |
| Cefotaxime+ Vancomicine | 10 | 5 |
| Ceftriaxone + Clindamycin | 9 | 4.5 |
| Clindamycin | 5 | 2.5 |
| Cefotaxime + Clindamycin | 5 | 2.5 |
| Others | 10 | 5 |
Two patients of positive cases were boy and four were girl. Five positive cases were observed among other antibiotic treatments. Positive results were not related to sex and age of the patients, duration of hospitalization, antibiotic consumption and diarrhea (p>0.05).
In this study the prevalence of nosocomial diarrhea due to C. difficile was 6 (3%).
Statistical tests indicated no significant difference in the ELISA positivity prevalence in stool samples of the patients with nosocomial regarding for the duration of hospitalization in day. This could be due to the low number of ELISA-positive stool samples of patients with nosocomial diarrhea.
It is concluded that C. difficile is an important reason for nosocomial diarrhea and the most important prescribed antibiotic is cefotoxim. Determining the prevalence of C. difficile and the types of strategies that can deal with this pathogen is important. It is recommended in future studies polymerase chain reaction be used to test and determine the strains of bacteria because this test is more accurate.
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