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Title: $Investigation of Clostridium difficile antigen, toxin A+B and toxin genes in cases of hospital acquired diarrhea
Abstract: Background: This study aimed to identify the toxin production and toxin gene profiles of Clostridium difficile species through investigation of C.difficile antigen glutamate dehydrogenase, toxinA + B and toxin genes in the stool samples of cases of hospital acquired enteritis. Methods & Materials: Eighty-three patients between 2012-2013 were included in the study. Data of the patients were reached through screening the computerized operating system of the hospital and patient files. Results: Risk factors such as presence of malignancy, chronic diseases, chemotherapy, radiotherapy and immunosuppression were present in the majority of the patients (Table). C.difficile antigen was found to be positive in 5 patients using membrane enzyme immunoassay. ToxinA + B positivity was not found in any patients with membrane EIA. Toxin-B gene positivity was found in 3 out of 5 patients with C.difficile antigen positivity with real-time polymerase chain reaction method. Binary toxin gene positivity and single base deletion in nucleotide 117 of the tcdC gene were found in no patients. In conclusion, C.difficile infection was identified in 3 patients and C.difficile colonization with non-toxigenic species was determined in 2 patients. The incidence of hospital originated CDI was calculated to be 0,10/10,000 patient admission days and 0,06/10,000 patient presentation. Table Epidemiological data of the patientsTabled 1Epidemiological dataNumber (%)ClinicInternal74 (%90,2)Surgical5 (%6,1)ICU*Intensive Care Unite3 (%3,7)Antibiotic usage1 antibiotic23 (%40,4)2 antibiotic24 (%42,1)≥3 antibiotic10 (%17,5)ChemotherapyNo46 (%56,1)Yes36 (%43,9)RadiotherapyNo80 (%97,6)Yes2 (%2,4)Chronic diseaseNo51 (%62,2)Yes31 (%37,8)MalignancyNo43 (%52,4)Yes39 (%47,6)* Intensive Care Unite Open table in a new tab Conclusion: CDI is seen in varying rates in different hospitals and countries. In addition, the test methods and kits used conditions of transport, storage, examination of the samples and the epidemiological characteristics of the patients might influence the CDI rates. We believe that the antibiotic usage policies and infection control precautions that are in practice in our hospital for a long time are closely related with the low rates of CDI's seen in this study. GDH screening with EIA method in patients with probable infectious enteritis and verification by PCR in patients with GDH positivity is considered as a quick, effective and reliable method.