Abstract
INTRODUCTION: Clostridium difficile is a Gram-positive spore-bearing anaerobic bacillus increasingly
associated with both community- and hospital-acquired colitis and diarrhea. It is
the most common identifiable bacterial cause of healthcare-associated diarrhea associated
with antibiotic use and one of the most common anaerobic infections. The diagnosis
of C. difficile infection includes detection of toxin A/B in stool specimens by direct
enzyme immunoassay, culture of pathogen from the stool specimens using a selective
agar Cycloserine-Cefoxitin fructose agar (CCFA), tissue culture assay, and detection
of glutamate dehydrogenase an enzyme produced by C. difficile. With few reports from
India on this disease, the present study was planned to throw more light on the prevalence
and utility of laboratory diagnostic methods for C. difficile-associated diarrhea
(CDAD).
MATERIAL AND METHODS: After taking approval from the Ethics Committee, 150 patients with antibiotic-associated
diarrhea were taken as a study group and fifty patients with exposure to antibiotics
but who did not develop diarrhea were taken as controls. Stool specimen was processed
for both culture on CCFA and toxin detection by IVD Tox A + B ELISA.
RESULTS: Only four specimens were culture positive, whereas 13 were ELISA positive. All culturepositive
isolates were toxigenic. C. difficile was neither isolated nor its toxin detected
in the control group. Culture- and toxin-based assays may not detect all cases of
CDAD.
CONCLUSION: Based on the results of the present study, culture does not provide any additional
yield over toxin assay. Better diagnostic modalities would be required to prove CDAD.
Key words
Clostridium difficile
- culture - ELISA
