Prevalence and antimicrobial resistance pattern of Clostridium difficile among hospitalized diarrheal patients: A systematic review and meta-analysis

Background Clostridium difficile is the leading cause of infectious diarrhea that develops in patients after hospitalization during antibiotic administration. It has also become a big issue in community-acquired diarrhea. The emergence of hypervirulent strains of C. difficile poses a major problem in hospital-associated diarrhea outbreaks and it is difficult to treat. The antimicrobial resistance in C. difficile has worsened due to the inappropriate use of broad-spectrum antibiotics including cephalosporins, clindamycin, tetracycline, and fluoroquinolones together with the emergence of hypervirulent strains. Objective To estimate the pooled prevalence and antimicrobial resistance pattern of C. difficile derived from hospitalized diarrheal patients, a systematic review and meta-analysis was performed. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to review published studies conducted. We searched bibliographic databases from PubMed, Scopus, Google Scholar, and Cochrane Library for studies on the prevalence and antimicrobial susceptibility testing on C. difficile. The weighted pooled prevalence and resistance for each antimicrobial agent was calculated using a random-effects model. A funnel plot and Egger’s regression test were used to see publication bias. Results A total of 15 studies were included. Ten articles for prevalence study and 5 additional studies for antimicrobial susceptibility testing of C. difficile were included. A total of 1967/7852 (25%) C. difficile were isolated from 10 included studies for prevalence study. The overall weighted pooled proportion (WPP) of C. difficile was 30% (95% CI: 10.0–49.0; p<0.001). The analysis showed substantial heterogeneity among studies (Cochran’s test = 7038.73, I2 = 99.87%; p<0.001). The weighed pooled antimicrobial resistance (WPR) were: vancomycin 3%(95% CI: 1.0–4.0, p<0.001); metronidazole 5%(95% CI: 3.0–7.0, p<0.001); clindamycin 61%(95% CI: 52.0–69.0, p<0.001); moxifloxacin 42%(95% CI: 29–54, p<0.001); tetracycline 35%(95% CI: 22–49, p<0.001); erythromycin 61%(95% CI: 48–75, p<0.001) and ciprofloxacin 64%(95% CI: 48–80; p< 0.001) using the random effect model. Conclusions A higher weighted pooled prevalence of C. difficile was observed. It needs a great deal of attention to decrease the prevailing prevalence. The resistance of C. difficile to metronidazole and vancomycin was low compared to other drugs used to treat C. difficile infection. Periodic antimicrobial resistance monitoring is vital for appropriate therapy of C. difficile infection.

A Rare Case of Pseudomembranous Colitis Presenting with Pleural Effusion and Ascites with Literature Review

Clostridium difficile infection usually results from long-term and irregular antibiotic intake. The high-risk individuals for this infection include the patients undergoing chemotherapy due to malignancy, immunocompromised patients, and hospitalized patients receiving broad-spectrum antibiotics. The most common clinical manifestation of Clostridium difficile infection is diarrhea. However, pleural effusion and ascites have rarely been observed. As mentioned, these manifestations can be developed in a patient being treated with broad-spectrum antibiotics. Therefore, the present study reports a rare case of Clostridium difficile infection manifesting with these rare manifestations who was a 78-year-old female patient with a history of COVID-19, orthopedic surgery, and antibiotic treatment with cefixime and gentamicin.

Mycophenolate Mofetil and Clostridium difficile-associated Colitis

Aim. A clinical observation of colitis conditioned by mycophenolate mofetil intake and concomitant Clostridium difficile-associated disease.Key points. Mycophenolate mofetil (MMF) is an active immunosuppressant with side effects affecting gastrointestinal tract (GIT). A 37-yo male patient with type 1 diabetes mellitus was admitted at a gastroenterology unit with clinical signs of diarrhoea with haematochezia. A history of diabetic nephropathy and related-donor pre-dialysis kidney transplantation in 2012, since when MMF intake was 2000 mg daily. Catarrhal ulcerative colitis in colonoscopy, C. difficile toxins in pathogen stool panel. Ulcerative, ischaemic colitises and the graft-versus-host disease were ruled out in examination. A positive clinical and endoscopic trend was observed upon MMF withdrawn and start of vancomycin.Conclusion. The case presented illustrates the clinical picture and diagnostic algorithm in MMF-associated colitis. The case-distinctive is association with C. difficile infection.