Introduction: This study aimed to identify the toxin production and toxin gene profiles of Clostridium difficile species through investigation of C. difficile antigen glutamate dehydrogenase, toxin A/B, and toxin genes in the stool samples of cases of hospital- acquired enteritis.
Materials and methods: This observational prospective study was performed to investigate the place of C. difficile in hospital- acquired diarrhea between September 29, 2012, and September 4, 2013. Eighty-two patients between 2012 and 2013 were included in the study. The wards at which patients were admitted, causes of hospitalization, patients’ demographics and underlying diseases were recorded. Glutamate dehydrogenase (GDH) and toxin A/B were investigated using enzyme immunoassay (EIA). In addition, toxin B, binary toxin genes, and tcdC gene deletion were analyzed with a real time-PCR.
Results: A total of 82 patients were included in the study. C. difficile antigen was positive in 5 patients using enzyme immu- noassay. Toxin A/B positivity was not found in any patients with enzyme immunoassay. Toxin-B gene positivity was found in 3 out of 5 patients with C. difficile antigen positivity with the real-time polymerase chain reaction method. Binary toxin gene positivity and sin- gle base deletion in nucleotide 117 of the tcdC gene were found in no patients. The incidence of hospital-originated C. difficile infec- tion was calculated as 0.10 per 10,000 patient days and 0.06 per 10,000 patient admissions.
Conclusion: CDI is seen in varying rates in different hospitals and countries. In addition, the test methods and kits used, tran- sport, storage, and sample examination conditions, and the patients’ epidemiological characteristics might influence the CDI rates. We believe that the antibiotic use policies and infection control precautions in practice in our hospital for a long period are closely related to the low rates of CDIs seen in this study.
C. difficile, health care associated diarrhea, toxin genes, Toxin A/B